Perceived Barriers and Facilitators of Implementing a Multicomponent Intervention to Improve Communication With Older Adults With and Without Dementia (SHARING Choices) in Primary Care: A Qualitative Study.
Perceived Barriers and Facilitators of Implementing a Multicomponent Intervention to Improve Communication With Older Adults With and Without Dementia (SHARING Choices) in Primary Care: A Qualitative Study.
复制标题
DOI：
10.1177/21501319221137251
复制
发表时间：
2022-01
影响因子：
3.6
通讯作者：
Wolff, Jennifer L.
中科院分区：
文献类型：
--
作者：
Smith, Kelly M.;Scerpella, Danny;Guo, Amy;Hussain, Naaz;Colburn, Jessica L.;Cotter, Valerie T.;Aufill, Jennifer;Dy, Sydney M.;Wolff, Jennifer L.
关键词：
实施以患者和家庭为中心的沟通策略已被证明在初级保健中具有挑战性，特别是对于痴呆症患者。为了解决这个问题，我们设计了共享的选择，一个多组分的干预相结合的病人和家庭合作的议程设置，电子门户网站访问，并支持提前护理计划（ACP）。这项定性描述性研究描述了影响初级保健中实施共享选择的因素。半结构化访谈或焦点小组与患者/家庭二人组（家庭，朋友，无偿照顾者）和初级保健利益相关者（临床医生，工作人员，管理人员）引起了感知的障碍和促进共享选择的实施。现场记录和访谈记录使用模板分析沿着实施研究的综合框架（CFIR）结构进行编码。内容分析确定的主题不容易在CFIR分类。大约22对夫妇（包括14名认知障碍患者）和30名利益相关者参与了这项研究。参与者接受分享选择的组成部分。共享选择的使能因素包括干预的适应性，家庭的有目的参与（特别是痴呆症患者），与组织优先事项的一致性，以及与当前实践相比共享选择的相对优势。实施的障碍包括干预的复杂性，空间限制，工作流程和ACP犹豫。ACP主持人被认为是支持解决个人和组织的实施障碍，包括患者健康和技术素养和临床医生的ACP讨论时间。患者、家庭和初级保健临床医生赞同分享选择的目标和个人组成部分。提高采用率的策略是简化材料，简化流程，利用现有的工作流程，并在初级保健团队中嵌入ACP促进者。
Implementing patient- and family-centered communication strategies has proven challenging in primary care, particularly for persons with dementia. To address this, we designed SHARING Choices, a multicomponent intervention combining patient and family partnered agenda setting, electronic portal access, and supports for advance care planning (ACP). This qualitative descriptive study describes factors affecting SHARING Choices implementation within primary care. Semi-structured interviews or focus groups with patient/family dyads (family, friends, unpaid caregivers) and primary care stakeholders (clinicians, staff, administrators) elicited perceived barriers and facilitators of SHARING Choices implementation. Field notes and interview transcripts were coded using template analysis along the Consolidated Framework for Implementation Research (CFIR) constructs. Content analysis identified themes not readily categorized within CFIR. About 22 dyads, including 14 with cognitive impairment, and 30 stakeholders participated in the study. Participants were receptive to the SHARING Choices components. Enablers of SHARING Choices included adaptability of the intervention, purposive engagement of family (particularly for patients with dementia), consistency with organizational priorities, and the relative advantage of SHARING Choices compared to current practices. Perceived barriers to implementation included intervention complexity, space constraints, workflow, and ACP hesitancy. The ACP facilitator was perceived as supportive in addressing individual and organizational implementation barriers including patient health and technology literacy and clinician time for ACP discussions. Patients, family, and primary care clinicians endorsed the objectives and individual components of SHARING Choices. Strategies to enhance adoption were to simplify materials, streamline processes, leverage existing workflows, and embed ACP facilitators within the primary care team.
登录
查看更多内容
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
2.8
作者：
Keary S;Moorman SM
通讯作者：
Moorman SM
影响因子：
2.9
作者：
Bernard, Carrie;Tan, Amy;Howard, Michelle
通讯作者：
Howard, Michelle
影响因子：
2.2
作者：
Howard, Michelle;Langevin, Jessica;Heyland, Daren K.
通讯作者：
Heyland, Daren K.
影响因子：
2.2
作者：
Dy, Sydney M.;Scerpella, Daniel L.;Cotter, Valerie;Colburn, Jessica;Roth, David L.;McGuire, Maura;Giovannetti, Erin Rand;Walker, Kathryn A.;Hussain, Naaz;Sloan, Danetta H.;Boyd, Cynthia M.;Cockey, Kimberley;Sharma, Neha;Saylor, Martha Abshire;Smith, Kelly M.;Wolff, Jennifer L.
通讯作者：
Wolff, Jennifer L.