Age and ageing · 2025
Understanding barriers and facilitators to implementation of consensus-based recommendations for the management of very old people in intensive care.
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Bourne Richard S, Alberto Laura, Brummel Nathan E, de Groot Bas, De Lange Dylan W, Elbers Paul, Emmelot-Vonk Marielle H, Flaatten Hans, Freund Yonathan, Galazzi Alessandro, Garcia-Martinez Ana, Guidet Bertrand, Holmerová Iva, Jacobs Jeremy M, Joynt Gavin M, Leaver Susannah, Leone Marc, McNicholas Bairbre, McWilliams David, Metaxa Victoria, Nickel Christian H, Poole Daniele, Robba Chiara, Roedl Kevin, Romain Marc, Rousseau Anne-Françoise, Sigal Sviri, Szczeklik Wojciech, Vallet Hélène, van Oppen James, Jung Christian, Beil Michael
Аннотация
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.
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.