Improving the sustainability of advance care planning for older adults with serious chronic illnesses in primary care: protocol for a mixed-methods process evaluation of a tailored multifaceted knowledge translation intervention
Notice bibliographique
Résumé
Abstract Background: Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of evidence-based practice interventions are rare. This protocol describes the methodology for a post-implementation research project that will add value to a recently completed randomized controlled trial study comparing the effectiveness of team-based to clinician-focused models for implementing a recognized advance care planning (ACP) training program called SICP (The Serious Illness Care Program). SICP has been implemented in 40 primary care practices recruited from seven Practice-Based Research Networks (PBRNs) in the US and Canada. The aim of this study is to contribute to knowledge on optimal strategies to improve the sustainability of ACP use among healthcare professionals (HPs) providing care to older adults with serious chronic illnesses in primary care and factors that influence ACP sustainability. Methods: The specific objectives of this study will be accomplished using a mixed methods sequential explanatory design nested within a five-phase process evaluation guided by Intersectionality Theory and the Integrated Sustainability Framework. Phase 1 of the study will involve a user-centered design (UCD) approach and qualitative methods to explore barriers and facilitators to ACP sustainability with knowledge users (KUs), which will be mapped to theoretically informed strategies for improving ACP sustainability. Using results from Phase 1, Phase 2 will follow an Evidence-Based Quality Improvement (EBQI) process engaging KUs to identify potentially effective sustainability strategies for ACP use that match priorities/needs and co-design an ACP-focused sustainability intervention that will be tailored to the primary care context. Phase 3 will comprise a quasi-experiment involving up to eight primary care practices with one experimental group of an ACP-focused sustainability intervention and one wait-list control group. The primary outcome will include measures that ACP has successfully been used by primary care HPs, by conducting a medical chart review of eligible older patients with serious chronic illnesses over a 12-month period. Secondary outcomes will include additional provider-level measures such as HPs’ beliefs about ACP, self-efficacy to ACP use, and perceived acceptability of ACP for patients. Phase 4 will use interpretive description and individual semi-structured interviews with a subsample of HPs and local managers who participated in Phase 3 to explore factors influencing ACP sustainability. Finally, quantitative and qualitative results from Phases 3 and 4 will be integrated in Phase 5 to uncover key conditions for improving ACP sustainability in primary care, using a joint display technique. Discussion: This project strives to advance knowledge on optimal strategies for sustainable practice changes introduced through the implementation of evidence-based practice interventions and to deepen our understanding of the factors that influence sustainability. Our results will inform KUs (e.g., patients, clinicians, managers, policymakers) regarding the sustainability of knowledge translation (KT) interventions for ACP. An integrated KT plan of our results will be tailored to end-users and include passive (e.g., publications, website posting) and interactive (e.g., social media, knowledge exchange events with stakeholders) strategies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,020 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».