e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Staff perspectives on the adoption and feasibility of a clinical pathway for anxiety and depression in cancer care, and mid-implementation adaptations (#277)

Phyllis Butow 1 , Heather Shepherd 1 , Jessica Cuddy 1 , Nicole Rankin 2 , Marnie Harris 1 , Sharon He 1 , Peter Grimison 3 , Afaf Girgis 4 , Mona Faris 1 , The ADAPT Program Group 5 , Joanne Shaw 1
  1. School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
  2. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  3. Chris O'Brien Lifehouse, Sydney, NSW, Australia
  4. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia
  5. ADAPT Program, Group

Background: Clinical pathways (CPs), intended to standardise and improve care, may not always produce positive outcomes, possibly due to lack of fit to the specific context in which they were enacted. This qualitative study explored staff perspectives of a CP implementation for routine screening, assessment, referral and management of anxiety and depression (ADAPT CP) for cancer patients.

Methods: The ADAPT CP was implemented in 12 oncology services, which were randomised into core versus enhanced implementation strategies. Core sites received support until implementation commencement and could access progress reports. Enhanced sites received proactive, ongoing support during the 12-month implementation. Staff were interviewed prior to implementation (n=88) and 6 months later (n=89). Monthly meetings with multi-disciplinary teams at the eight enhanced sites were recorded.

Results: Thematic analysis revealed six overarching themes: ADAPT is of high value; timing is difficult; online screening is challenging; a burden too much; no-one to refer patients to; and micrologistics are key. While early screening was deemed desirable, diverse barriers meant this was complex, with adaptations made to time and screening location. Online screening prompted by email, seen as time-saving and efficient, also proved unsuccessful in some services, with adaptations made to include in-clinic or phone screening. Staff negative attitudes to the ADAPT program, time constraints, and perceived poor fit of ADAPT to work roles, all impacted implementation, with key tasks often devolving to key individuals. Nevertheless, services remained committed to the ADAPT CP, and worked hard to create, review and adapt strategies to address challenges to optimise success.

Conclusions: This study demonstrates the interactive nature of health service change, with staff engaging with, forming views on, and problem-solving adaptations of the ADAPT CP to overcome barriers. Obtaining staff feedback is critical to ensure health service change is sustainable, meaningful and achieves its promise of improving patient outcomes.