How do clinicians use implementation tools to apply breast cancer screening guidelines to practice?
How do clinicians use implementation tools to apply breast cancer screening guidelines to practice?
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DOI：
10.1186/s13012-018-0765-2
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发表时间：
2018-06-07
期刊：
影响因子：
--
通讯作者：
Straus SE
中科院分区：
文献类型：
--
作者：
Armson H;Roder S;Elmslie T;Khan S;Straus SE
实施工具(ITool)可能会增强对指导方针的理解。然而，关于初级保健临床医生使用它们的证据很少。这项研究探讨了临床医生使用哪些iTool以及使用频率；临床医生对工具的满意度；工具的使用是否与实践改变相关；并确定了与乳腺癌筛查相关的实践改变的中介因素(S)。加拿大初级保健提供者是以实践为基础的小组学习计划(n = 1464)的成员，他们被邀请参加这项混合方法研究。在小组学习环境中讨论了一个教育模块，数据收集包括在线调查、实践反思工具(PRTS)和访谈。该模块包括加拿大预防保健工作组修订的BCS指南和供临床医生和/或患者使用的iTool。在讨论了单元和3个月后，参与者完成了PRT，确定了他们计划的实践变化(S)，并记录了实施结果(S)。通过在线调查和个人采访探索了iTool的使用情况。70名参与者同意参加。其中，48人参加了在线调查，43人完成了PRTS，14人接受了采访。大多数调查参与者(77%)报告至少使用了七种工具中的一种来实施BCS指南。其中(78%)报告使用了不止一种工具。几乎所有参与者都为临床医生使用工具(92%)，62%的参与者也为患者使用工具。随着更多工具的使用，报告了更多关于调查和PRT的做法变化。采访提供了更多的发现。一旦来自iTool的信息内部化，就不再需要该工具。参与者没有使用工具(23%)，因为与BCS指南、患者的期望和/或乳腺癌诊断经验不一致。本研究发现，临床医生使用工具来实施与BCS指南相关的实践变更。为临床医生开发的工具用于理解和巩固建议，然后使用用于患者的工具来促进决策。影响工具使用的中介因素证实了先前的研究。最后，一些iTool的使用随着时间的推移而减少，因为信息是内部化的。本文的在线版本(10.1186/s13012-0180765-2)包含补充材料，授权用户可以使用。
Implementation tools (iTools) may enhance uptake of guidelines. However, little evidence exists on their use by primary care clinicians. This study explored which iTools clinicians used and how often; how satisfied clinicians were with the tools; whether tool use was associated with practice changes; and identified mediators for practice change(s) related to breast cancer screening (BCS). Canadian primary care providers who are members of the Practice-Based Small Group Learning Program (n = 1464) were invited to participate in this mixed methods study. An educational module was discussed in a small group learning context, and data collection included an on-line survey, practice reflection tools (PRTs), and interviews. The module included both the Canadian Task Force on Preventive Health Care revised guideline on BCS and iTools for clinician and/or patient use. After discussing the module and at 3 months, participants completed PRTs identifying their planned practice change(s) and documenting implementation outcome(s). Use of the iTools was explored via online survey and individual interviews. Seventy participants agreed to participate. Of these, 48 participated in the online survey, 43 completed PRTs and 14 were interviewed. Most survey participants (77%) reported using at least one of seven tools available for implementing BCS guideline. Of these (78%) reported using more than one tool. Almost all participants used tools for clinicians (92%) and 62% also used tools for patients. As more tools were used, more practice changes were reported on the survey and PRTs. Interviews provided additional findings. Once information from an iTool was internalized, there was no further need for the tool. Participants did not use tools (23%) due to disagreements with the BCS guideline, patients’ expectations, and/or experiences with diagnosis of breast cancer. This study found that clinicians use tools to implement practice changes related to BCS guideline. Tools developed for clinicians were used to understand and consolidate the recommendations before tools to be used with patients were employed to promote decision-making. Mediating factors that impacted tool use confirmed previous research. Finally, use of some iTools decreased over time because information was internalized. The online version of this article (10.1186/s13012-018-0765-2) contains supplementary material, which is available to authorized users.
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DOI：
10.1186/s13012-017-0605-9
发表时间：
2017-06-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Atkins L;Francis J;Islam R;O'Connor D;Patey A;Ivers N;Foy R;Duncan EM;Colquhoun H;Grimshaw JM;Lawton R;Michie S
通讯作者：
Michie S
影响因子：
3.5
作者：
Elwyn G;Scholl I;Tietbohl C;Mann M;Edwards AG;Clay C;Légaré F;van der Weijden T;Lewis CL;Wexler RM;Frosch DL
通讯作者：
Frosch DL
DOI：
10.9778/cmajo.20140064
发表时间：
2015-01-01
期刊：
CMAJ open
影响因子：
--
作者：
Gagliardi, Anna R;Brouwers, Melissa C;Bhattacharyya, Onil K
通讯作者：
Bhattacharyya, Onil K
DOI：
10.1186/1748-5908-7-37
发表时间：
2012-04-24
期刊：
Implementation science : IS
影响因子：
--
作者：
Cane J;O'Connor D;Michie S
通讯作者：
Michie S
影响因子：
2.8
作者：
Gagliardi AR
通讯作者：
Gagliardi AR