Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Implementing psychosocial PROM in routine clinical practice: Challenges and strategies (#133)

Phyllis Butow 1 2 , Heather L Shepherd 1 2 , Joanne Shaw 1 , Liesbeth Geerligs 1 , Lindy Masya 1 , Jessica Cuddy 1 , Mona Faris 1 , Haryana M Dhillon 1 2 , Thomas F Hack 3 4 , Afaf Girgis 5 , Tim Luckett 6 , Melanie Lovell 7 8 , Brian Kelly 9 , Philip Beale 10 , Peter Grimison 11 12 , Rosalie Viney 13 , Nicole M Rankin 14 , Laura Kirsten 15 , Josephine Clayton 7 8
  1. Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
  2. CeMPED/ PoCoG, The University of Sydney, NSW, Australia
  3. Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Canada
  4. Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Winnipeg, Canada
  5. Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW
  6. Faculty of Health, University of Technology Sydney, Ultimo, NSW
  7. HammondCare Northern Sydney, Greenwich, NSW
  8. Northern Clinical School, University of Sydney, Sydney, NSW
  9. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW
  10. Cancer Services for the Sydney Local Health District (Incorporating Royal Prince Alfred, Concord and Canterbury Hospitals), Sydney, NSW
  11. Chris O’Brien Lifehouse, Camperdown, NSW
  12. Sydney Medical School, University of Sydney, Sydney, NSW
  13. Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, Sydney, NSW
  14. Implementation Science Research in Implementation Science and e-Health (RISe) Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW
  15. Psychosocial services, Nepean Cancer Care Centre, Pentrith. , NSW

Background

Screening for anxiety and depression is recommended in international guidelines but rarely implemented. The Psycho-Oncology Co-operative Research Group developed an evidence-based clinical pathway (CP) for cancer-related anxiety and depression, and an online portal with accompanying resources to enact it (ADAPT).  

Objectives

This study compared the clinical- and cost-effectiveness of two implementation strategies (core versus enhanced), designed to encourage adherence to the ADAPT CP over a 12-month period.

Methods

A cluster randomized controlled trial in 12 NSW Oncology services was completed in December 2020. Sites were stratified by size and randomized to core versus enhanced implementation arms. After 6-8 engagements sessions to tailor the CP to site requirements, clarify staff roles and receive training, each site implemented ADAPT for 1 year, recruiting patients as part of standard care. Staff completed questionnaires and interviews at baseline (T0) assessing attitudes and readiness for change, and at mid (T1) and post implementation (T2) assessing perceived acceptability and feasibility of ADAPT and impact of implementation strategies.

Results and Conclusions

Participating sites were: metropolitan (n=7) or rural (n=5); public (n=10), public and private (n=1) or private (n=1). 106 and 88 staff completed questionnaires and interviews at T0, with some drop-off over time. 696 patients completed initial screening, 627 at least one follow-up screen. Acceptability of ADAPT was very high (mean of 32/35) but staff also perceived moderate burden (mean 11/20) associated with its delivery. Staff believed ADAPT is evidence-based and serves a local need, benefiting patients (improved psychosocial outcomes), staff (new skills) and the service (data to demonstrate good care or to support request for additional staff). Perceived challenges were staff time, duplicated data-entry, and patient barriers. Average cost per patient was $126. A trend observed for health care utilisation to be reduced after registration on ADAPT, suggested cost savings. With institutional commitment, adequate resourcing and support for staff, ADAPT can make a difference to patient and health system outcomes.