Healthcare providers’ cognitive perception and experience of shared decision-making of vascular access led by intravenous therapy nurses under the daytime chemotherapy mode: a qualitative study_West China Medical Journal

Authors：

LI Mengqi ,  SUN Bei , WANG Yang , SUN Yingming , ZHANG Jingjing , SONG Hui , ZHAO Xingyang

1. Department of Day Care Ward, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P. R. China;

Corresponding author：

SUN Bei, Email: sunpei@tjmuch.com

Keywords：

Shared decision-making; daytime chemotherapy; vascular access; SWOT analysis; qualitative study

DOI：

10.7507/1002-0179.202309204

Video：

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Objective To clarify the views of healthcare providers on the current vascular access shared decision-making model under the daytime chemotherapy mode, and to determine improvement measures to promote the conventional implementation of the daytime chemotherapy vascular access shared decision-making model. Methods Based on the SWOT model, an interview outline was developed. Using purposive sampling method, 7 doctors and 6 intravenous therapy nurses working at Tianjin Medical University Cancer Institute & Hospital from April to June 2023 were selected for semi-structured interviews, and content analysis method was used for data analysis. Results Four themes were extracted for internal advantages: alleviating the pressure of diagnosis and treatment and decision-making for doctors, ability and willingness of specialized intravenous therapy nurses to implement, promoting the rational selection of vascular pathways, enhancing the recognition of vascular pathways in daytime chemotherapy patients, and enhancing communication stickiness between nurses and patients. Four themes were extracted for internal weaknesses: increased workload, impractical decision support tools, unsmooth implementation processes, and incomplete informatization. Three themes were extracted for external opportunities: national policy support, willingness of daytime chemotherapy patients to participate in decision-making, and sufficient evidence-based evidence. Three themes were extracted for external threats: poor communication between healthcare providers under daytime chemotherapy mode, cognitive differences related to intravenous therapy among healthcare providers, and insufficient confidence in nurse leadership. Conclusions The vascular pathway shared decision-making led by intravenous therapy nurses has certain advantages in the daytime chemotherapy mode. In the future, we should seize existing opportunities, avoid our own weaknesses, face external threats, and develop a standardized vascular access shared decision-making model led by intravenous therapy nurses under the daytime chemotherapy mode, promoting the best evidence-based practice for vascular access decision-making during daytime chemotherapy.

Citation： LI Mengqi, SUN Bei, WANG Yang, SUN Yingming, ZHANG Jingjing, SONG Hui, ZHAO Xingyang. Healthcare providers’ cognitive perception and experience of shared decision-making of vascular access led by intravenous therapy nurses under the daytime chemotherapy mode: a qualitative study. West China Medical Journal, 2024, 39(2): 234-239. doi: 10.7507/1002-0179.202309204 Copy

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2.	Elwyn G, Frosch DL, Kobrin S. Implementing shared decision-making: consider all the consequences. Implement Sci, 2016, 11: 114.
3.	Stacey D, Murray MA, Légaré F, et al. Decision coaching to support shared decision making: a framework, evidence, and implications for nursing practice, education, and policy. Worldviews Evid Based Nurs, 2008, 5(1): 25-35.
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8.	Zisman-Ilani Y, Obeidat R, Fang L, et al. Shared decision making and patient-centered care in Israel, Jordan, and the United States: exploratory and comparative survey study of physician perceptions. JMIR Form Res, 2020, 4(8): e18223.
9.	Hulse AL. Clinical competency assessment in intravenous therapy and vascular access: part 1. Br J Nurs, 2013, 22(16): 933-934, 936-937.
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11.	Robinson T, Geary RL, Davis RP, et al. Arteriovenous fistula versus graft access strategy in older adults receiving hemodialysis: a pilot randomized trial. Kidney Med, 2021, 3(2): 248-256.e1.
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14.	Scholl I, Hahlweg P, Lindig A, et al. Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial. Implement Sci, 2021, 16(1): 106.
15.	国家卫生健康委办公厅. 国家卫生健康委办公厅关于印发医疗机构日间医疗质量管理暂行规定的通知. 中华人民共和国国家卫生健康委员会公报, 2022(11): 4-6.
16.	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice, 8th edition. J Infus Nurs, 2021, 44(Suppl 1): S1-S224.
17.	国家卫生和计划生育委员会. 静脉治疗护理技术操作规范. 中国护理管理, 2014(1): 1-3.
18.	Keij SM, de Boer JE, Stiggelbout AM, et al. How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies. BMJ Open, 2022, 12(5): e057293.
19.	杨煦, 陈京, 刘巍, 等. 肿瘤专科医院日间病房诊疗模式的建立与管理. 中国医学前沿杂志(电子版), 2021, 13(5): 2-5.
20.	Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns, 2014, 94(3): 291-309.
21.	言克莉, 顾则娟, 李金花, 等. 应用护理质量指标提高静脉化疗护理质量的实践. 中华护理杂志, 2013, 48(3): 232-234.
22.	吴欣娟, 丁炎明, 郑一宁. 我国 30 家三级甲等医院 2019 年—2020 年《静脉治疗护理技术操作规范》实施现状调查. 中国护理管理, 2022, 22(9): 1281-1284.
23.	Hayes D, Edbrooke-Childs J, Town R, et al. Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the theoretical domains framework. Eur Child Adolesc Psychiatry, 2019, 28(5): 655-666.
24.	Abuzour AS, Lewis PJ, Tully MP. Practice makes perfect: a systematic review of the expertise development of pharmacist and nurse independent prescribers in the United Kingdom. Res Social Adm Pharm, 2018, 14(1): 6-17.
25.	Latter S, Courtenay M. Effectiveness of nurse prescribing: a review of the literature. J Clin Nurs, 2004, 13(1): 26-32.

1. 马飞. 认识中国肿瘤日间诊疗现状. 中国医学前沿杂志(电子版), 2021, 13(5): 前插 1, 1.
2. Elwyn G, Frosch DL, Kobrin S. Implementing shared decision-making: consider all the consequences. Implement Sci, 2016, 11: 114.
3. Stacey D, Murray MA, Légaré F, et al. Decision coaching to support shared decision making: a framework, evidence, and implications for nursing practice, education, and policy. Worldviews Evid Based Nurs, 2008, 5(1): 25-35.
4. Savelberg W, Boersma LJ, Smidt M, et al. Does lack of deeper understanding of shared decision making explains the suboptimal performance on crucial parts of it? An example from breast cancer care. Eur J Oncol Nurs, 2019, 38: 92-97.
5. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci, 2009, 4: 50.
6. van Wijngaarden JD, Scholten GR, van Wijk KP. Strategic analysis for health care organizations: the suitability of the SWOT-analysis. Int J Health Plann Manage, 2012, 27(1): 34-49.
7. Gürel E, Tat M. SWOT analysis: a theoretical review. Int J Soc Res Methodol, 2017, 10(51): 994-1006.
8. Zisman-Ilani Y, Obeidat R, Fang L, et al. Shared decision making and patient-centered care in Israel, Jordan, and the United States: exploratory and comparative survey study of physician perceptions. JMIR Form Res, 2020, 4(8): e18223.
9. Hulse AL. Clinical competency assessment in intravenous therapy and vascular access: part 1. Br J Nurs, 2013, 22(16): 933-934, 936-937.
10. Bos-van den Hoek DW, Thodé M, Jongerden IP, et al. The role of hospital nurses in shared decision-making about life-prolonging treatment: a qualitative interview study. J Adv Nurs, 2021, 77(1): 296-307.
11. Robinson T, Geary RL, Davis RP, et al. Arteriovenous fistula versus graft access strategy in older adults receiving hemodialysis: a pilot randomized trial. Kidney Med, 2021, 3(2): 248-256.e1.
12. Hahlweg P, Lindig A, Frerichs W, et al. Major influencing factors on routine implementation of shared decision-making in cancer care: qualitative process evaluation of a stepped-wedge cluster randomized trial. BMC Health Serv Res, 2023, 23(1): 840.
13. Danner M, Geiger F, Wehkamp K, et al. Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a northern German university hospital. BMJ Open, 2020, 10(10): e037575.
14. Scholl I, Hahlweg P, Lindig A, et al. Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial. Implement Sci, 2021, 16(1): 106.
15. 国家卫生健康委办公厅. 国家卫生健康委办公厅关于印发医疗机构日间医疗质量管理暂行规定的通知. 中华人民共和国国家卫生健康委员会公报, 2022(11): 4-6.
16. Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice, 8th edition. J Infus Nurs, 2021, 44(Suppl 1): S1-S224.
17. 国家卫生和计划生育委员会. 静脉治疗护理技术操作规范. 中国护理管理, 2014(1): 1-3.
18. Keij SM, de Boer JE, Stiggelbout AM, et al. How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies. BMJ Open, 2022, 12(5): e057293.
19. 杨煦, 陈京, 刘巍, 等. 肿瘤专科医院日间病房诊疗模式的建立与管理. 中国医学前沿杂志(电子版), 2021, 13(5): 2-5.
20. Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns, 2014, 94(3): 291-309.
21. 言克莉, 顾则娟, 李金花, 等. 应用护理质量指标提高静脉化疗护理质量的实践. 中华护理杂志, 2013, 48(3): 232-234.
22. 吴欣娟, 丁炎明, 郑一宁. 我国 30 家三级甲等医院 2019 年—2020 年《静脉治疗护理技术操作规范》实施现状调查. 中国护理管理, 2022, 22(9): 1281-1284.
23. Hayes D, Edbrooke-Childs J, Town R, et al. Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the theoretical domains framework. Eur Child Adolesc Psychiatry, 2019, 28(5): 655-666.
24. Abuzour AS, Lewis PJ, Tully MP. Practice makes perfect: a systematic review of the expertise development of pharmacist and nurse independent prescribers in the United Kingdom. Res Social Adm Pharm, 2018, 14(1): 6-17.
25. Latter S, Courtenay M. Effectiveness of nurse prescribing: a review of the literature. J Clin Nurs, 2004, 13(1): 26-32.

West China Medical Journal

Healthcare providers’ cognitive perception and experience of shared decision-making of vascular access led by intravenous therapy nurses under the daytime chemotherapy mode: a qualitative study

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