Implementing a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a mixed-methods analysis of implementation using the Consolidated Framework for Implementation Research

BMC Health Services Research

Danielle Hitch¹  Sally Butzkueven²  Jessie Varghese³  Kate Fetterplace⁴  Kate Fox⁵  Aurora Ottaway⁶  Vanessa Carter⁶  Kathryn Pierce⁶  Irene Deftereos⁷  Justin M Yeung⁸  Nicole Kiss⁹  Belinda Steer^1,10 

[1]Allied Health, Western Health, Melbourne, Australia

[2]Occupational Therapy, Deakin University, Geelong, Australia

[3]Cancer Services, Western Health, Melbourne, Australia

[4]Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia

[5]Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia

[6]Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia

[7]Department of Nutrition and Dietetics, St Vincent’s Hospital Melbourne, Melbourne, Australia

[8]Department of Nutrition and Dietetics, Western Health, Melbourne, Australia

[9]Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia

[10]Department of Nutrition and Dietetics, Western Health, Melbourne, Australia

[11]Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia

[12]Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia

[13]Department of Colorectal Surgery, Western Health, Melbourne, Australia

[14]Sunshine Hospital, Level 3, WCHRE Building, 176 Furlong Rd, 3021, St Albans, VIC, Australia

[15]Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia

[16]Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia

[17]Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia

关键词: Gastrointestinal cancer;    Nutrition support;    Nutrition care pathway;    Qualitative;    Dietitian;    Multidisciplinary team;   

DOI  :  10.1186/s12913-022-07466-9

来源: Springer

【 摘 要 】

BackgroundImplementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR).MethodsThis was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4–8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data.ResultsQualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points).ConclusionsThe nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication.

【 授权许可】

CC BY