Article(id=1322165036613747631, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322164984558243894, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.01.023, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1743264000000, receivedDateStr=2025-03-30, revisedDate=1763222400000, revisedDateStr=2025-11-16, acceptedDate=null, acceptedDateStr=null, onlineDate=1793158309366, onlineDateStr=2026-10-28, pubDate=1767974400000, pubDateStr=2026-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793158309366, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793158309366, creator=13701087609, updateTime=1793158309366, updator=13701087609, issue=Issue{id=1322164984558243894, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='1', pageStart='1', pageEnd='176', issueExtLink='null', onlineDate='null', pubDate='1767974400000', pubDateStr='2026-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793158296955, creator='13701087609', updateTime=1793158296955, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=155, endPage=159, ext={EN=ArticleExt(id=1322165038845117360, articleId=1322165036613747631, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Application progress of consolidated framework for implementation research in oncology nursing, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This article reviewed the origin,core components,and current application status of the consolidated framework for implementation research(CFIR) in oncology nursing,and analyzed its developments,limitations, and future prospects.The aim was to promote the development of CFIR in China.

, authors=Jiaxue FU1, 2, Linghao ZENG1, Yongyi CHEN1, Ouying CHEN2, Yawen XU1, 2, Hailun ZHAO1, Dong WU1, 2, authorsList=Jiaxue FU, Linghao ZENG, Yongyi CHEN, Ouying CHEN, Yawen XU, Hailun ZHAO, Dong WU, authorCompany=null, correspAuthors=Yongyi CHEN, authorNote=null, correspAuthorsNote=
CHEN Yongyi, E-mail:
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综述实施性研究综合框架(consolidated framework for implementation research,CFIR)的起源、核心内容以及在肿瘤护理中的应用现况,并分析实施性研究综合框架的发展、不足及展望未来,旨在促进实施性研究综合框架在我国的发展。

, authors=付佳雪1, 2, 曾令好1, 谌永毅1, *, *, 陈偶英2, 许亚文1, 2, 赵海伦1, 吴东1, 2, authorsList=付佳雪, 曾令好, 谌永毅, 陈偶英, 许亚文, 赵海伦, 吴东, authorCompany=null, correspAuthors=谌永毅, authorNote=

付佳雪,硕士研究生在读

, correspAuthorsNote=
谌永毅,E-mail:
CHEN Yongyi, E-mail:
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实施性研究综合框架在肿瘤护理中的应用进展
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付佳雪 1, 2 , 曾令好 1 , 谌永毅 1, *, * , 陈偶英 2 , 许亚文 1, 2 , 赵海伦 1 , 吴东 1, 2
护理研究 | 科研综述 2026,40(1): 155-159
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护理研究 |科研综述 2026 , 40 (1) : 155 -159
实施性研究综合框架在肿瘤护理中的应用进展
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付佳雪1, 2, 曾令好1, 谌永毅1, *, * , 陈偶英2, 许亚文1, 2, 赵海伦1, 吴东1, 2
作者信息
  • 1湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院,湖南 410000
  • 2湖南中医药大学护理学院
通讯作者:
谌永毅,E-mail:
CHEN Yongyi, E-mail:
作者简介:

付佳雪,硕士研究生在读

Application progress of consolidated framework for implementation research in oncology nursing
Jiaxue FU1, 2, Linghao ZENG1, Yongyi CHEN1 , Ouying CHEN2, Yawen XU1, 2, Hailun ZHAO1, Dong WU1, 2
Affiliations
  • 1Hunan Cancer Hospital/Cancer Hospital Affiliated to Xiangya Medical College, Central South University, Hunan 410000 China
  • 2School of Nursing, Hunan University of Traditional Chinese Medicine
  • Corresponding Author:
    CHEN Yongyi, E-mail:
出版时间: 2026-01-10 doi: 10.12102/j.issn.1009-6493.2026.01.023
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综述实施性研究综合框架(consolidated framework for implementation research,CFIR)的起源、核心内容以及在肿瘤护理中的应用现况,并分析实施性研究综合框架的发展、不足及展望未来,旨在促进实施性研究综合框架在我国的发展。

癌症  /  肿瘤护理  /  实施性研究综合框架  /  理论结构  /  综述

This article reviewed the origin,core components,and current application status of the consolidated framework for implementation research(CFIR) in oncology nursing,and analyzed its developments,limitations, and future prospects.The aim was to promote the development of CFIR in China.

cancer  /  oncology nursing  /  consolidated framework for implementation research(CFIR)  /  theoretical structure  /  review
付佳雪, 曾令好, 谌永毅, 陈偶英, 许亚文, 赵海伦, 吴东. 实施性研究综合框架在肿瘤护理中的应用进展. 护理研究, 2026 , 40 (1) : 155 -159 . DOI: 10.12102/j.issn.1009-6493.2026.01.023
Jiaxue FU, Linghao ZENG, Yongyi CHEN, Ouying CHEN, Yawen XU, Hailun ZHAO, Dong WU. Application progress of consolidated framework for implementation research in oncology nursing[J]. Chinese Nursing Research, 2026 , 40 (1) : 155 -159 . DOI: 10.12102/j.issn.1009-6493.2026.01.023
近年来,实施科学(implementation science,IS)快速发展,其是一种促进循证实践、干预措施和政策被常规医疗保健和公共卫生健康所采用和整合的研究方法,核心目标是通过系统化方法促进循证实践在临床中的有效应用,从而改善病人结局[1]。实施性研究综合框架(consolidated framework for implementation research,CFIR)作为其中使用频次较高且涵盖范围广泛的主流概念框架[2],为其提供了全面的分析视角,能够帮助研究者识别影响照护计划成功的关键因素。CFIR框架在肿瘤护理中的应用逐渐增多,其系统性、灵活性以及实践性为干预照护计划策略的制定与执行提供了重要的理论支撑[3],但相较于国外,我国在此领域的探索尚处于起步阶段[4]。因此,现阐述CFIR框架的起源、发展、核心内容及在肿瘤护理中的应用,分析该框架的不足、优势及展望,为研究者的循证决策与活动提供科学指导。
CFIR框架诞生于实施性研究领域对系统化理论工具的需求。21世纪初,随着医疗健康领域对“如何将循证实践有效转化为现实应用”的关注度提升,研究者发现,现有实施理论存在碎片化且缺乏统一标准的问题,导致研究和实践难以横向比较或整合[5]。在此背景下,Damschroder等[6]于2009年发表了题为“Fostering implementation of health services research findings into practice:a consolidated framework for advancing implementation science”里程碑式的论文,正式提出CFIR框架,该框架的构建基于对19个经典实施理论模型的系统性综述,通过整合共性要素,形成了一个多层次的综合分析工具,旨在为实施性研究提供统一的理论基础。CFIR框架最初提出时包含干预特征、外部环境、内部环境、个体特征、实施过程5个核心领域和39个相关子要素,覆盖了从干预设计到执行的全链条影响因素,其结构化特征使其迅速成为实施科学领域的主流框架[7]。近年来,学界围绕CFIR框架的要素冗余性、动态交互关系不足等问题展开讨论,推动其迭代。2022年,Damschroder等[8]提出“CFIR 2.0”概念,强调对实施过程中时间动态性和复杂系统效应的关注,进一步融入复杂性科学视角。
实施性研究综合框架作为实施科学领域的核心分析工具,其理论建构体现多维度、多层次的特征系统,具体内涵如下。
这部分聚焦干预方案特征(intervention characteristics),着重解构干预方案本身的科学属性与可实施性,涵盖方案来源(source of plan)、证据强度(strength of evidence)、相对优势(relative advantage)、可调整性(adjustability)、可试用性(trialability)等8个关键构念,其中复杂性(complexity)构念强调需从技术难度、操作步骤及资源需求维度评估干预方案的实施可行性。
外部环境系统考察宏观政策环境与利益相关者网络,包含政策激励(policy incentives)、病人需求(patient needs)、同业竞争(competition among peers)等4个变量;特别通过外部协作(external collaboration)构念揭示组织间网络对实施过程的规范作用。
内部因素着力分析组织内部实施情境,包括结构特征(structural feature)、协作与沟通(collaboration and communication)、内部文化(internal culture)、实施氛围(implementation atmosphere)和实施准备度(readiness for implementation)5个主要构成要素,这些因素相互关联并影响干预方案的实施。
个体特征采用社会认知理论视角,解析实施主体认知行为机制。核心构念包括知识信念(knowledge & beliefs)、自我效能(self-efficacy)及个体变革阶段(individual stage of change)、个体对组织认同感(organizational identity)和其他个人特点(personal characteristics),着重揭示行为意向到实践转化的心理路径。
实施过程建立动态实施模型,主要是指个体和组织层面促进干预方案被采纳的方法,涵盖计划(planning)、动员(mobilize)、执行(executing)、反思与评价(reflecting & evaluating)4个阶段。
CFIR框架为探索和优化肿瘤病人症状管理干预措施的有效性和可持续性提供了创新性方法指导。宋莹婵茜等[9]基于CFIR理论框架,开展了“医院-社区-家庭”三级联动模式下癌痛病人居家照护的促进及障碍因素质性研究,采用面对面开放式访谈法收集数据,访谈提纲严格依据CFIR框架设计,并运用CFIR框架中的内部因素和外部因素进行定向内容分析;共识别出8个促进因素、2个中性因素及14个障碍因素;结果证实,“医院-社区-家庭”三级联动模式下的癌痛病人居家照护模式不仅契合当前癌痛病人及其家属的实际需求,同时也顺应我国分级诊疗的政策导向。Minteer等[10]利用CFIR框架围绕患者报告结局(PROs)实施症状管理干预的障碍与促进因素展开评估,通过混合性研究方法多角度识别关键问题,发现技术层面存在PROs平台与医疗系统整合困难、操作层面缺乏明确的数据响应流程、文化层面面临传统管理模式惯性阻力的问题;研究结果为优化病人症状管理照护计划提供了理论与实践依据。
借助CFIR框架,研究者可以从不同角度出发识别影响方案实施的潜在因素[11]。Cole等[12]在一项临床研究中,采用CFIR框架对基于循证的结直肠癌筛查项目进行调整和优化,对管理者和临床医护人员进行半结构式访谈收集数据,并利用CFIR框架整合数据,识别出了影响项目成功进行的关键因素。Reid等[13]利用CFIR框架指导移动式醋酸染色肉眼观察(mobile inspección visual con ácido acético system,VIA)系统的设计,通过定量和定性的研究方法(问卷调查、访谈、实地观察)收集数据,并结合CFIR框架5个维度分析影响该系统实施的关键因素,结果表明,CFIR框架为优化移动式VIA系统提供了系统化指导,有助于提升其在资源有限地区的可行性和效果,为宫颈癌筛查的实施和推广提供了理论和实践支持。Bowen等[14]基于CFIR框架通过定性方法探讨了在社区实施乳腺癌和卵巢癌风险筛查工具的障碍与促进因素,研究发现,资源限制、目标群体对癌症的认知偏差、碎片化的医疗体系以及筛查工具本身的适用性缺陷是阻碍社区有效推广筛查服务的主要挑战。该研究还为实践者与政策制定者提供了基于循证的策略,强调以社区为中心、资源公平分配和跨领域协作在癌症筛查服务中的关键作用。
CFIR框架为数字健康技术的实施与应用提供了系统化的步骤和方法,确保实施过程科学、高效,并能及时调整策略以应对挑战。随着数字健康技术的快速发展,基于正念的移动应用程序(mindfulness-based mobile applications,MBMA)在改善青少年和年轻成人癌症幸存者的心理健康方面展现出巨大潜力[15]。然而,其成功实施和广泛应用受到多层次因素的影响;Kwok等[15]通过混合方法研究设计,结合CFIR框架对定性和定量数据进行分析,深入探讨了个体、组织和社会层面对MBMA实施的关键作用,为优化数字健康干预措施提供了重要依据。此外,Ardito等[16]通过范围综述,基于CFIR框架系统评估了移动健康应用程序(mHealth Apps)在癌症护理中的推广与应用所面临的障碍和促进因素;识别出用户友好设计、个性化功能、跨学科协作及政策支持等促进因素,同时指出技术素养不足、数据隐私问题、资源限制及病人依从性低等主要障碍,研究结果为优化mHealth Apps的设计与实施提供了理论依据,强调了在推广过程中需综合考虑技术、组织、个体和政策等多层次因素,以提升其在肿瘤病人照护中的可行性和效果。
2010年后,基于CFIR框架的配套工具(如定性编码手册、定量测量量表)陆续推出,研究者可通过CFIR官方网站(https://cfirguide.org/)在线构建质性研究的访谈指南,并下载用于质性研究资料收集的观察清单和资料分析的编码手册[17]。2017年更新的《CFIR技术辅助工具包》提供了标准化的数据收集与分析方法,增强了框架的操作性。Waltz等[18]在2019年依据“实施变革的专家意见”(expert recommendations for implementing change,ERIC)开发了一款名为CFIR-ERIC实施策略匹配工具(implementation strategy matching tool,CFIR-ERIC),其能精准匹配实施策略,为克服障碍因素提供了有力支持。例如,Lopez等[19]开发了一款癌症康复电子前瞻性监测系统(electronic prospective surveillance model for cancer rehabilitation,ePSM),通过早期识别和管理癌症病人症状及心理问题改善康复效果;在此项目实施前对相关利益者进行了半结构化访谈并利用CFIR框架进行整合,结合研究目的及实施情境确定了22种主要障碍因素,而后借助CFIR-ERIC对实施策略进行了可操作化的开发、优化与验证,最终筛选出了31项契合的改进策略;结果强调,成功实施ePSM需要优化技术设计、提供资源保障、加强培训并提升病人依从性。也有个别学者根据CFIR理论框架编制了量化工具,用以更加客观地测量与评估新干预的实施情况。以约翰霍普金斯大学Dy等[20-21]的创新实践为例,其系统梳理CFIR框架,对既有评估工具实施多维度优化,通过文献筛选、条目适配与跨场景验证等科学流程,开发了一项用于安宁疗护团队评估照护质量的调查工具,该工具创新性地采用模块化设计,涵盖质量改进基础架构(30项)、人员特质与环境特征(18项)、团队协作效能(11项)、质量管理支持体系(54项)及项目感知评价(11项)5个维度,经验证显示信效度良好。研究证实,该工具可显著提升症状管理方案与病人需求的匹配精度,对优化住院病人临床结局具有重要价值。但需要注意的是,目前此类量化工具并未进行大范围应用,亟待通过多中心、大样本研究深入挖掘CFIR框架在循证实践中的量化评估潜能。
RE-AIM框架是实施科学中涵盖过程及结果的全面评价模型之一,旨在系统评估干预措施的实际效果和可持续性[22]。研究表明,CFIR框架可与RE-AIM框架联合使用,不仅可以确定各维度的障碍及促进因素,同时可以评估干预措施实施过程和结局,优化资源利用,形成最佳的实施策略以促进干预的可持续性[23]。Cuba等[24]探讨了AMBORA能力与咨询中心优化口服抗肿瘤治疗(OAT)药物安全性的方法学路径,结合RE-AIM和CFIR框架,通过混合研究方法评估其实施效果及影响因素。研究发现,AMBORA中心通过个性化病人教育、药物监测和跨学科协作显著提升了肿瘤护理领域用药安全性;RE-AIM框架评估了干预措施的覆盖范围、有效性、采用率、实施质量和可持续性,而CFIR框架系统分析了干预特征、外部环境、内部环境、个体特征和实施过程等关键因素。两者的结合为AMBORA中心OAT的实施提供了全面的评估和优化路径,既关注实际效果,又深入分析实施过程中的复杂影响因素,研究结果为肿瘤护理领域药物安全使用提供了方法学理论指导。
CFIR框架整合了19个实施科学领域经典理论的要素,涵盖五大核心领域和39个子维度[6]。这种多层次结构为研究者提供了全面的分析框架,能够系统识别影响干预措施落地的复杂因素。相较于单一理论模型,CFIR框架的整合性显著提升了研究的理论饱和度[25]。此外,CFIR框架被证实在医疗、公共卫生、教育等多领域具有强跨学科适用性。例如,Kirk等[3]通过CFIR框架分析医院质量改进项目时,发现其能有效揭示组织文化与领导力对实施效果的影响机制;在教育领域,Wendt等[26]成功应用CFIR框架解析教师对新课程的看法。这种跨领域通用性得益于其模块化设计,允许研究者根据情境选择相关维度[27]。与此同时,CFIR框架不限定具体研究方法,可兼容质性、量性或混合方法。如张燕[28]结合CFIR框架与定量分析,量化了干预特征对病人预后的影响权重;同时,其结构化的编码手册为质性数据分析提供了标准化工具,提升了研究可重复性[29]。这种灵活性使其成为实施效果评估与优化干预设计的理想框架。结论指出,CFIR框架为健康照护计划的制定与实施提供了创新性的理论支持和实践指导,有助于提升照护质量和效率,是一种高效且科学的实施研究工具。
尽管CFIR框架为实施性研究提供了系统化的理论整合工具,但其仍存在以下几点不足。第一,CFIR框架整合了多个理论,涵盖五大领域39个构念,导致框架内容庞杂[6];实际应用中,研究者可能因构念间的重叠性和模糊边界而难以精准操作化[29],尤其对新手而言学习门槛较高。第二,静态视角局限:CFIR框架偏向于静态因素分类,对实施过程中动态变化的反馈机制缺乏深入探讨[30],可能低估实施策略的适应性需求。第三,文化敏感性不足:CFIR框架的构建基于西方医疗背景,对非西方文化或资源匮乏地区的特殊情境解释力有限[31],建议结合其他理论补充文化维度。第四,转化指导薄弱:CFIR框架擅长因素识别,但对“如何从诊断过渡到行动”缺乏明确路径[32]。例如,它未直接关联具体实施策略与障碍/促进因素的对应关系,需依赖ERIC工具实现转化。第五,实证验证不均衡:部分要素,如“外部政策激励”的测量效度和适用性尚未得到充分验证,可能影响研究结论的普适性[3]。目前,采用CFIR框架探索干预措施实施的障碍及促进因素的研究较多发表于国外期刊,国内研究发表较少,且均存在报告质量不高、报告形式不统一、不规范等问题[4]。因此,用户在使用CFIR框架时,需结合研究的需要,审慎考虑,而非盲目采纳。
虽然CFIR框架在肿瘤病人照护领域的应用仍存在一些不足,但其为理解和改善肿瘤病人照护计划提供了坚实的理论基础、系统方法学指导以及全面的研究视角。以“CFIR framework”和“cancer nursing”为检索词在MedLine中进行检索,结果显示CFIR框架已经被广泛应用于癌症筛查、远程医疗等领域。未来CFIR框架的发展应更加注重与肿瘤护理专业特点的深度融合,具体可体现在开发针对特定肿瘤病种、治疗阶段或护理环境的定制化版本,同时加强对病人及家属参与度、动态变化过程以及实施效果评估的关注。目前,国内相关领域对该框架的应用还非常有限,以“CFIR框架”为关键词在中国知网进行检索,仅发现1篇肿瘤病人照护领域的研究[9]采用该框架对干预方案的影响因素进行评估且未涉及策略制定环节。今后我国研究者可借鉴CFIR框架的理念和思路,突破传统干预方案影响因素分析的局限,提高研究的内在和外在真实性;也可通过简化框架结构层次、纳入动态系统理论或整合混合研究方法等,增强CFIR框架的实践适配性。同时,开展跨文化比较研究和工具开发以提升其普适性。相信随着CFIR框架的不断完善和应用研究的深入开展,其在推进肿瘤护理实践变革、改善病人预后和提高生存质量方面将发挥更加重要的作用,为肿瘤病人带来更多福祉。

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doi: 10.12102/j.issn.1009-6493.2026.01.023
  • 接收时间:2025-03-30
  • 首发时间:2026-10-28
  • 出版时间:2026-01-10
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  • 收稿日期:2025-03-30
  • 修回日期:2025-11-16
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    1湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院,湖南 410000
    2湖南中医药大学护理学院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
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红菇属 Russula 17 8.13
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