[en] Abstract
Background
Recent consensus-based recommendations on the management of people aged ≥80 years in intensive care units (ICUs) were developed to guide the management of quality care.
Objective
To understand perceived barriers and facilitators to consensus-based recommendations to support their implementation into multi-professional and disciplinary clinical practice.
Methods
Analysis of comments made by an international multiprofessional group of intensive care, emergency and geriatric medicine specialists in the Delphi consensus on the management of people aged ≥80 years in ICUs. Barrier and facilitators were analysed using the Theoretical Domains Framework.
Results
Care statement comments were provided by 99 of the 124 (79.8%) participants completing the Delphi first round; primarily identifying barriers (239/258; 92.6%). Most participants identified limitations in the environmental context and resources within the healthcare system (152, 63.6%); predominantly limitations in resources/material resources, with staffing (60, 25.1%), and beds or facilities (30, 12.6%) concerns. Potentially modifiable domains focused on inadequate knowledge (25, 10.5%), beliefs about consequences (18, 7.5%), care goals (16, 6.7%) and social/professional role and identity (16, 6.7%). Facilitators focused on improving staff knowledge, particularly amongst geriatric medicine and intensive care medicine specialities, and environmental context and resources (both 8, 42.1%).
Conclusions
The environmental context and resources domain was the most common barrier identified. Behaviour change opportunities are centred on the domains knowledge, beliefs about consequences, goals and social/professional role and identity. Linked behaviour change techniques can be identified and developed according to local healthcare context to support implementation of care recommendations.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Bourne, Richard S ; Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , ; National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC) , University of Manchester, Manchester,
Alberto, Laura; Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigación en Medicina y Ciencias de la Salud, Universidad del Salvador, Ciudad de Buenos Aires ,
Brummel, Nathan E; Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University College of Medicine , Columbus, Ohio , ; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center , Columbus, Ohio ,
de Groot, Bas; Department of Emergency Medicine, Radboudumc , Nijmegen, GE , ; Research Centre for Emergency Medicine, Aarhus University Hospital , Aarhus, Central Denmark Region ,
De Lange, Dylan W ; Department of Intensive Care Medicine, Utrecht University , Heidelberglaan 100, Utrecht, Utrecht 3584 CX ,
Elbers, Paul; Department of Intensive Care Medicine, Amsterdam University Medical Center Locatie Academic Medical Center , Amsterdam , ; Center for Critical Care Computational Intelligence, Vrije Universiteit , Amsterdam ,
Emmelot-Vonk, Marielle H; Department of Geriatrics, University Medical Centre Utrecht , Utrecht ,
Flaatten, Hans ; Department of Research and Development, Haukeland Universitetssjukehus , Bergen ,
Freund, Yonathan; IMProving Emergency Care, University Hospital Federations, Sorbonne Université , Paris, Île-de-France , ; Emergency Department, Assistance Publique—Hopitaux de Paris, Pitié-Salpétrière Hospital , Paris, Île-de-France ,
Galazzi, Alessandro; Department of Medicine and Surgery, Libera Università Mediterranea, Casamassima, Bari ,
Garcia-Martinez, Ana; Emergency Department, IDIBAPS, Hospital Clínic , Barcelona ,
Guidet, Bertrand; Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Universite , Paris, Île-de-France , ; Service de Réanimation Médicale, Assistance Publique—Hôpitaux de Paris , Paris, Île-de-France ,
Holmerová, Iva; Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Prague, Charles University , Prague ,
Jacobs, Jeremy M ; Department of Geriatric Rehabilitation and Center for Palliative Care, Hadassah Medical Center , Jerusalem, Jerusalem District , ; Faculty of Medicine, Hebrew University of Jerusalem , Jerusalem, Jerusalem District ,
Joynt, Gavin M; Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong ,
Leaver, Susannah; General Intensive Care, St George’s University Hospitals NHS Foundation Trust , London ,
Leone, Marc; Department of Anaesthesia and Intensive Care Medicine, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University , Marseille ,
McNicholas, Bairbre; Department of Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway , County Galway,
McWilliams, David; Centre for Care Excellence, Coventry University , Coventry ,
Metaxa, Victoria; Department of Critical Care, King’s College Hospital NHS Foundation Trust , London , ; Centre for Education, Faculty of Life Sciences and Medicine, King’s College London , London ,
Nickel, Christian H; Emergency Department, University Hospital Basel, Basel, Switzerland ; Department of Clinical Research , University of Basel, Basel ,
Poole, Daniele; Operative Unit of Pain Therapy, Ospedale San Martino Belluno , Belluno, Veneto ,
Robba, Chiara ; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa, Liguria , ; Dipartimento di Scienze Chirurgiche Diagnostiche ed Integrate, University of Genoa , Genoa, Liguria ,
Roedl, Kevin; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf , Hamburg ,
Romain, Marc; Department of Medical Intensive Care , Hadassah Medical Center, Jerusalem, ; Faculty of Medicine , Hebrew University of Jerusalem, Jerusalem ,
Rousseau, Anne-Françoise ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
Sigal, Sviri; Department of Medical Intensive Care , Hadassah Medical Center, Jerusalem, ; Faculty of Medicine , Hebrew University of Jerusalem, Jerusalem ,
Szczeklik, Wojciech; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College , Krakow ,
Vallet, Hélène; Service de Gériatrie Aigue/UPREG, Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine , Paris, Île-de-France , ; Centre d’Immunologie et de Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale (INSERM) , Sorbonne Université, Paris, Île-de-France ,
van Oppen, James; Centre for Urgent and Emergency Care Research, The University of Sheffield , Sheffield , ; Department of Population Health Sciences, University of Leicester , Leicester ,
Jung, Christian ; Department of Cardiology, Pulmonology and Vascular Medicine and Cardiovascular Research Institute Düsseldorf, Heinrich-Heine-Universitat Dusseldorf , Düsseldorf, NRW ,
Beil, Michael; Department of Medicine, National Health Service Highland , Inverness ,
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