Attitudes Toward Interprofessional Health Care Teams in a Regional Cancer Institute: A Cross-Sectional Survey Study.

OBJECTIVES: Oncology is a rapidly changing clinical setting. Research has shown improved patient outcomes and staff satisfaction following interprofessional collaborative education, but there has been limited research on perceptions of interprofessional collaboration among oncology health care professionals. The aims of this study were to: 1) assess attitudes of health care professionals toward interprofessional teams in oncology care, and 2) assess for differences in attitudes across various demographic and workplace groups. DATA SOURCES: The research design was an electronic cross-sectional survey. The main instrument utilized was the Attitudes Toward Interprofessional Health Care Teams (ATIHCT) survey. A total of 187 oncology health care professionals from a regional New England cancer institute completed the survey. The ATIHCT mean score was high (M = 4.07, SD = 0.51). Analysis revealed statistically significant differences in mean score among participant age groups (P = .03). Significant differences (P = .01) were also noted between different professional groups and their time constraints sub-scale score on the ATIHCT scale. A higher mean score occurred in participants who had a current certification (M = 4.13, SD = 0.50) compared to those without (M = 4.05, SD = 0.46). CONCLUSION: High overall scores in attitudes toward health care teams suggest that cancer care settings are primed for interprofessional care model implementation. Future studies should examine strategies to improve attitudes among specific groups. IMPLICATIONS FOR NURSING PRACTICE: Nurses are in a position to lead interprofessional teamwork in the clinical setting. Further research is necessary to examine best collaborative models in health care to support interprofessional teamwork.

Identification of Implementation Strategies Using the CFIR-ERIC Matching Tool to Mitigate Barriers in a Primary Care Model for Older Veterans.

BACKGROUND AND OBJECTIVES: As the proportion of the U.S. population over 65 and living with complex chronic conditions grows, understanding how to strengthen the implementation of age-sensitive primary care models for older adults, such as the Veterans Health Administration's Geriatric Patient-Aligned Care Teams (GeriPACT), is critical. However, little is known about which implementation strategies can best help to mitigate barriers to adopting these models. We aimed to identify barriers to GeriPACT implementation and strategies to address these barriers using the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) Matching Tool. RESEARCH DESIGN AND METHODS: We conducted a content analysis of qualitative responses obtained from a web-based survey sent to GeriPACT members. Using a matrix approach, we grouped similar responses into key barrier categories. After mapping barriers to CFIR, we used the Tool to identify recommended strategies. RESULTS: Across 53 Veterans Health Administration hospitals, 32% of team members (n = 197) responded to our open-ended question about barriers to GeriPACT care. Barriers identified include Available Resources, Networks & Communication, Design Quality & Packaging, Knowledge & Beliefs, Leadership Engagement, and Relative Priority. The Tool recommended 12 Level 1 (e.g., conduct educational meetings) and 24 Level 2 ERIC strategies (e.g., facilitation). Several strategies (e.g., conduct local consensus discussions) cut across multiple barriers. DISCUSSION AND IMPLICATIONS: Strategies identified by the Tool can inform on-going development of the GeriPACT model's effective implementation and sustainment. Incorporating cross-cutting implementation strategies that mitigate multiple barriers at once may further support these next steps.

A Citation Review of 83 Dissemination and Implementation Theories, Models, or Frameworks Utilized in U.S.-Based Aging Research.

BACKGROUND AND OBJECTIVES: Dissemination-implementation.org outlines 110 theories, models, and frameworks (TMFs): we conducted a citation analysis on 83 TMFs, searching Web of Science and PubMed databases. RESEARCH DESIGN AND METHODS: Search terms were broad and included "aging," "older," "elderly," and "geriatric." We extracted each TMF in identified articles from inception through January 28, 2022. Included articles must have used a TMF in research or quality improvement work directly linked to older adults within the United States. RESULTS: We reviewed 2,681 articles of which 295 articles cited at least one of 56 TMFs. Five TMFs represented 50% of the citations: Reach, Effectiveness, Adoption, Implementation, and Maintenance 1.0, Consolidated Framework for Implementation Research, Greenhalgh Diffusion of Innovation in Service Organizations, Quality Enhancement Research Initiative, Community-Based Participatory Research, and Promoting Action on Research Implementation in Health Services. TMF application varied and there was a steady increase in TMF citations over time, with a 2- to 3-fold increase in citations in 2020-2021. We identified that only 41% of TMF use was meaningful. DISCUSSION AND IMPLICATIONS: Our results suggest TMF utilization is increasing in aging research, but there is a need to more meaningful utilize TMFs. As the population of older adults continues to grow, there will be increasing demand for effective evidence-based practices and models of care to be quickly and effectively translated into routine care. Use of TMFs is critical to building such evidence and to identifying and evaluating methods to support this translation.

Interprofessional clinical pathway program effects on patient outcomes in the setting of neutropenic fever: An integrative review.

PURPOSE: Neutropenic fever (NF) is an oncologic emergency linked to substantial healthcare costs, treatment delays, and increased patient mortality. Clinical pathways have emerged as a coordinated, interprofessional approach to NF management. The aim of this review was to examine the research question: What is the effect of an interprofessional clinical pathway program on outcomes (time-to-antibiotic, mortality, cost, readmissions and length of stay) in patients presenting with NF? METHODS: Using the integrative review method of Whittemore and Knafl, the databases PubMed, CINAHL and Scopus were searched for articles published in English between 1997 to present that met the following criteria: (1) reported clinical pathway implementation, and (2) reported outcome data on patients 18 years or older who were diagnosed with NF. RESULTS: Of the 17 included articles, 13 demonstrated improvement in reducing time-to-antibiotic following clinical pathway implementation. Three studies reported a reduction in mortality and two studies reported no change in patient mortality after NF clinical pathway integration. One study demonstrated a reduction in hospital readmissions, while three studies showed improvement in length of stay. None of the included studies reported data on cost reduction. Half of the articles articulated the different members of the interprofessional teams. CONCLUSION: The implementation of interprofessional clinical pathway programs for NF had positive effects on patient outcomes in this review. Measuring patient and institutional outcomes is necessary to evaluate the effectiveness of interprofessional clinical pathways in NF care. Future research should incorporate these measurements to improve the development and implementation of NF clinical pathways.