对改变提供者当前腭咽闭合不全评估与治疗决策的障碍与促进因素的定性探索。
A Qualitative Exploration of Barriers and Facilitators to Changing Provider's Current Evaluation and Treatment Decision-Making for Velopharyngeal Insufficiency.
文献信息
| PMID | 42852963 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Thomas J Sitzman |
| 作者单位 | Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. |
| 期刊 | The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association |
| SCI 分区 | Q3 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 识别改变提供者当前腭咽闭合不全（VPI）评估与治疗决策方法的障碍与促进因素。
设计： 横断面定性研究。
地点： 美国和加拿大从事临床研究的中型和大型多学科唇腭裂团队。
参与者： 来自12个唇腭裂团队的28名外科医生和16名言语语言病理学家。
干预： 进行半结构化访谈，探讨改变VPI评估与治疗决策的感知障碍与促进因素。访谈采用以实施研究综合框架为指导的主题方法进行分析。
结果： 提供者表示，采用新的VPI评估与决策方法需要证据证明能改善言语结局或降低阻塞性睡眠呼吸暂停风险。有说服力证据的特征包括前瞻性研究设计、可比患者组、标准化言语评估和长期随访。提供者倾向于将新方法应用于复杂病例或特定亚组，而非广泛采用。提供者对额外的术前检查表示担忧，认为可能增加治疗负担。在反思先前护理提供的变化时，提供者表示他们首先与团队成员非正式讨论潜在变化，以分享信息、收集意见并建立共识；在较大的团队中，讨论也在正式会议或通过行政层级进行。实施决策基于共识，尽管实施速度因提供者而异。
结论： 提供者有实施VPI评估与治疗决策变化的流程，以及决定实施的标准。这些发现可为设计实施策略提供信息，以加速研究发现的临床采纳。
英文摘要
ObjectiveTo identify barriers and facilitators to changing provider's current approaches to evaluation and treatment decision-making for velopharyngeal insufficiency (VPI).DesignCross-sectional qualitative study.SettingMedium and large multidisciplinary cleft teams in the USA and Canada engaged in clinical research.ParticipantsTwenty-eight surgeons and 16 speech-language pathologists from 12 cleft teams.InterventionsSemi-structured interviews were conducted exploring perceived barriers and facilitators to changing VPI evaluation and treatment decision-making. Interviews were analyzed using a thematic approach guided by the Consolidated Framework for Implementation Research.ResultsProviders indicated that adoption of new approaches to VPI evaluation and decision-making would require evidence demonstrating improved speech outcomes or reduced risk of obstructive sleep apnea. Characteristics of persuasive evidence included prospective study design, comparable patient groups, standardized speech evaluations, and long-term follow-up. Providers favored applying new approaches to complex cases or defined subgroups, rather than broad adoption. Providers raised concerns about additional preoperative testing, perceiving it could increase treatment burden. When reflecting on prior changes in care delivery, providers indicated they started by discussing the potential change informally with team members to share information, gather input, and build consensus; in larger teams, discussions also occurred in formal meetings or through administrative hierarchies. Implementation decisions were consensus-based, although the pace of implementation varied among providers.ConclusionsProviders have processes for implementing changes in their VPI evaluation and treatment decision-making, and criteria by which they make the decision to implement. These findings can inform the design of implementation strategies to accelerate clinical uptake of research findings.