Introduction
Materials and methods
Sample
Development of the Delphi materials
Use of the Theoretical Domains Framework
Domain label[12] | Domain content |
---|---|
Beliefs about consequences | Often regarded as core to clinical reasoning, this domain covers the perceived benefits and harms of a clinical action. In some contexts it can also include consequences for the clinician such as workload, pay, career progression, or for the hospital or health service. |
Behavioural regulation | Includes the ‘how’ of changing clinical practice: what are the practical strategies that would facilitate or hinder uptake of a new practice. |
Beliefs about capabilities | How confident clinicians are that they could change their practice effectively. |
Emotion | Includes issues such as work stress, patient anxiety and other emotional factors that may help or hinder the uptake of new approaches to care. |
Environmental context/resources | Includes the physical (including financial) issues that may limit change, including staffing levels and time as well as equipment or space. |
Knowledge | Knowledge of the field (that is, whether there is adequate evidence) and individuals’ knowledge of the evidence or of a guideline. |
Memory, attention and decision processes | The level of attention that is needed to perform the key clinical action (that is, whether forgetting is likely to be a problem) and the processes by which clinical decisions are made by individuals and teams. |
Motivation and goals | The relative priority that is given to one clinical issue, compared with other demands. |
Social/professional role and identity | The clinical thinking and norms of a particular profession. |
Skills | Covers the possibility that new skills would be required by the staff that are required to implement a new procedure. |
Social influences | The influence of other individuals or groups on clinical practice; for example, patients, patients’ families, pressure groups. |
Nature of the behaviours | Some new practices are very similar to current practice and so are easier to implement than new practices that require a dramatic change in ways of working. |
The Delphi rounds
Data management and analysis
Results
Participants
Participants’ self-reported knowledge of SDD
Stability of opinions
What was important to responders?
Domain of TDF[12] | Item stem | Median (IQR) |
---|---|---|
Beliefs about consequences | SDD increases antibiotic resistance | 8 (7 to 9) |
Decision processes | The decision to adopt SDD requires consensus between my colleagues | 8 (7 to 9) |
Knowledge | Research to date has not adequately addressed concerns about antibiotic resistance and SDD | 8 (7 to 9) |
Decision processes | The decision to adopt SDD requires a review and appraisal of the current best evidence | 8 (7 to 9) |
Behavioural regulation | My hospital tries to reduce antibiotic use | 8 (7 to 9) |
Decision processes | Part of the decision to adopt SDD requires agreement about which patients will receive it | 8 (7 to 9) |
Beliefs about consequences | SDD would increase ICU Clostridium difficile infections | 8 (6 to 8) |
Knowledge | I know the SDD evidence base well enough to have an informed opinion regarding its use | 8 (6 to 8) |
Motivation | We are addressing hospital-acquired infections using other strategies | 7 (6.5 to 9) |
Motivation | We are addressing ventilator-associated pneumonia using other strategies | 7 (7 to 8) |
Opinions about SDD
Opinions on the validity and adequacy of the evidence base and the consequences of implementing SDD
Opinions about the likely barriers to implementation
Opinions on feasibility of further research
Comparisons between stakeholder groups
Discussion
Opinions about SDD
Opinions about the evidence base
Barriers to implementation
Future research
Strengths and limitations
Conclusions
Key messages
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The evidence base for the effectiveness of SDD is strong but SDD will not be more widely implemented without further supportive evidence.
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Participants believe that further clinical research in this area needs to have significantly greater validity and generalisability.
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Further research must include monitoring of antibiotic resistance rates before, during and after the trial.
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SDD was not seen as a high priority and this could limit interest in further research.