Wienands Linda, Krumme Julia, Geest Sabina De, Kovács László, Teynor Alexandra, Valenta Sabine, Leppla Lynn
Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland.
Digit Health. 2025 Apr 29;11:20552076251336859. doi: 10.1177/20552076251336859. eCollection 2025 Jan-Dec.
eHealth-facilitated integrated care models (eICMs) offer promising enhancements to healthcare delivery in stem cell transplantation, but entail implementation and ethical challenges. While qualitative process evaluation methodologies can effectively address such issues through interdisciplinary collaboration, no previous studies have integrated approaches from implementation science and applied ethics into eICM evaluations.
Exploring an integrated approach to the qualitative process evaluation of a stem cell transplantation eICM (SMILe-ICM), our objectives were threefold: (1) assess the current SMILe-ICM's implementation through stakeholder perceptions; (2) examine relevant ethical issues; and (3) develop strategies to mitigate identified implementation and ethical challenges.
Semistructured individual interviews were conducted with 12 patients and 3 relatives. Additionally, 8 clinicians in total participated in two focus groups. Data analysis followed an inductive-deductive thematic approach built on interpretative frameworks from implementation science and medical ethics and supported by ethical consultations.
We isolated three main themes, centered on the patient's treatment journey and recovery, to explain patients', their relatives' and clinicians' perceptions regarding the SMILe-ICM. While the SMILe-ICM was generally viewed as valuable, perspectives varied regarding standardized procedures, including eHealth, and care coordination practices. These themes encompass implementation and ethical issues related to individual, intervention, inner setting, and outer setting factors, leading to the development of 17 implementation strategies.
This study provides nuanced insights into patient- and provider-level eICM implementation and ethical challenges. By identifying these issues early, the integrated research design and resulting strategies facilitated well-informed, timely solutions.
电子健康促进的综合护理模式（eICMs）为干细胞移植的医疗服务提供了有前景的改进，但也带来了实施和伦理方面的挑战。虽然定性过程评估方法可以通过跨学科合作有效地解决此类问题，但以前没有研究将实施科学和应用伦理学的方法整合到eICM评估中。
探索一种对干细胞移植eICM（SMILe-ICM）进行定性过程评估的综合方法，我们的目标有三个：（1）通过利益相关者的看法评估当前SMILe-ICM的实施情况；（2）检查相关伦理问题；（3）制定策略以减轻已识别的实施和伦理挑战。
对12名患者和3名亲属进行了半结构化个人访谈。此外，共有8名临床医生参加了两个焦点小组。数据分析采用基于实施科学和医学伦理学解释框架的归纳-演绎主题方法，并得到伦理咨询的支持。
我们分离出三个主要主题，以患者的治疗过程和康复为中心，来解释患者、其亲属和临床医生对SMILe-ICM的看法。虽然SMILe-ICM总体上被认为是有价值的，但对于包括电子健康在内的标准化程序和护理协调实践，不同人有不同的看法。这些主题涵盖了与个体、干预、内部环境和外部环境因素相关的实施和伦理问题，从而制定了17项实施策略。
本研究对患者和提供者层面的eICM实施及伦理挑战提供了细致入微的见解。通过尽早识别这些问题，综合研究设计及由此产生的策略有助于提供明智、及时的解决方案。
