Development and refinement of a complex intervention within cardiac rehabilitation services: experiences from the CADENCE feasibility study.
Development and refinement of a complex intervention within cardiac rehabilitation services: experiences from the CADENCE feasibility study.
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DOI：
10.1186/s40814-017-0123-1
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发表时间：
2017-01-01
影响因子：
1.7
通讯作者：
Turner, Katrina
中科院分区：
文献类型：
--
作者：
Winder, Rachel;Richards, Suzanne H;Turner, Katrina
背景：经历心脏事件的患者比普通人群患抑郁症的风险更高。尽管如此，心脏康复（CR）项目并未为抑郁症提供系统的心理护理方法。CADENCE研究旨在开发并试点一种由行为激活（BA）和心理健康护理协调组成的强化心理护理（EPC）干预措施。按照最初的研究委托指南，该干预措施计划嵌入常规护理中，由CR护士为参加CR的抑郁症患者提供。本文描述了如何使用定性方法来开发、嵌入和完善该干预措施。
方法：这项可行性研究涉及三个CR团队。对提供常规护理的CR护士、给予护士的EPC培训以及为CR护士提供的督导会议进行了观察。四名护士在接受EPC培训后不久接受了采访，三名护士在为患者提供EPC 6 - 7个月后再次接受了采访。所有九名被招募接受EPC的患者都接受了采访。对观察记录和访谈记录的分析侧重于如何在可接受性和实施方面改进干预措施。
结果：在CR团队之间发现了以下方面的差异：患者等待名单时间、CR的实施方式、可用设施以及为患者提供的CR疗程数量。EPC对护士和患者都是可接受的。然而，护士在现有工作量和资源范围内难以提供这种额外的护理，并且患者在CR项目中的进展受阻影响了EPC的实施。有限的时间和私人空间的可用性意味着护士也通过电话提供EPC，这被视为一种实用的解决方案，但不如面对面的方式可取。护士表示患者对一些书面材料存在困难。研究结果被用于修订干预措施，使其成为一种包括指导性自助BA的护理协调方案。
结论：通过访谈和观察获得的见解使我们能够确定实施EPC的障碍，并修改干预措施以促进其在现有服务范围内的实施，同时对护士和患者仍然可接受。所使用的多方法、迭代方法是这项定性研究成功的关键。
试验注册：ISRCTN34701576，注册于2014年5月29日。
BACKGROUND: Patients who experience a cardiac event are at higher risk of developing depression than the general population. Despite this, cardiac rehabilitation (CR) programmes do not provide a systematic approach to psychological care for depression. The CADENCE study aimed to develop and pilot an enhanced psychological care (EPC) intervention consisting of behavioural activation (BA) and mental health care coordination. Following original research commissioning guidance, the intervention was planned to be embedded in routine care and delivered by CR nurses to patients with depression attending CR. This paper describes how qualitative methods were used to develop, embed and refine the intervention.METHODS: This feasibility study involved three CR teams. Observations were made of CR nurses delivering usual care, of EPC training given to nurses, and of supervision sessions provided to the CR nurses. Four nurses were interviewed shortly after their EPC training, and three were interviewed again 6-7 months later having delivered EPC to patients. All nine patients recruited to receive EPC were interviewed. Analyses of the observation notes and interview transcripts focused on how the intervention could be improved in terms of its acceptability and implementation.RESULTS: Variations were found between the CR teams regarding patient waiting list times, how CR was delivered, what facilities were available and how many CR sessions were offered to patients. EPC was acceptable to both nurses and patients. However, nurses struggled to provide this additional care within their existing workload and resources, and patients' disrupted progression through the CR programme affected EPC delivery. Limited time and availability of private space meant nurses also delivered EPC by telephone, which was viewed as a pragmatic solution but less preferable than face-to-face. Nurses indicated that patients struggled with some of the written materials. Findings were used to revise the intervention to become a protocol of care coordination which included guided self-help BA.CONCLUSIONS: Insights gained through conducting interviews and observations enabled us to identify barriers to the implementation of EPC, and to modify the intervention to facilitate its delivery within existing services whilst remaining acceptable to both nurses and patients. The multiple method, iterative approach used was key to the success of this qualitative study.TRIAL REGISTRATION: ISRCTN34701576 Registered 29/05/2014.