An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER).
An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER).
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DOI：
10.1186/s43058-023-00530-3
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发表时间：
2023-11-24
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临床医生经常报告说，他们自己的焦虑和低自我效能阻碍了他们使用循证自杀预防措施，包括金标准筛查和简短干预。暴露疗法可以减少临床医生的适应不良焦虑，增强自我效能的使用，这是一种令人信服但未经检验的方法，可以改善以证据为基础的自杀预防实践（ebp）的实施。该项目汇集了一个跨学科团队，利用数十年的行为改变研究，从暴露理论到基于暴露的实施策略（EBIS）的设计和试点测试，以针对临床医生的焦虑，改善预防自杀的EBP实施。我们将开发、迭代完善和试点测试EBIS与常规实施（IAU；教学培训和咨询）相结合，为该策略在减少临床医生焦虑、提高自我效能、增加哥伦比亚自杀严重程度评定量表和门诊心理健康设置安全计划干预方面的效果进行更大规模的研究做准备。本研究的目的1是与利益相关者咨询委员会合作，使用参与式设计方法来开发和完善EBIS。目标2是利用快速循环原型技术，与多达15名临床医生在试点现场测试中迭代改进EBIS。目标3是在试点实施试验中测试改进后的EBIS。40名社区精神卫生临床医生将以1:1的比例随机接受IAU或IAU + EBIS，为期12周。我们的主要结果是EBIS的可接受性和可行性，通过问卷调查、访谈和招聘和保留统计来衡量。次要结果是目标实施机制的参与程度（与实施相关的临床医生焦虑和自我效能），以及通过混合方法（问卷调查、图表刺激回忆、观察者编码的角色扮演和访谈）评估EBIS对实施结果（采用和忠实度）的初步有效性。本研究的结果将深入了解直接针对临床医生焦虑和自我效能作为机制过程的可行性和实用性，为实施自杀预防EBPs提供信息。结果将为一项完全有效的混合有效性实施试验提供信息，以测试EBIS对实施和患者预后的影响。临床试验注册号：NCT05172609。注册日期：12/29/2021
Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation. We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS’ effect on implementation and patient outcomes. Clinical Trials Registration Number: NCT05172609. Registered on 12/29/2021.