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

Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: A mixed methods study of staff perspectives. (#279)

Phyllis Butow 1 , Heather Shepherd 1 2 , Jessica Cuddy 1 , Marnie Harris 1 , Sharon He 1 , Lindy Masya 1 , Mona Faris 1 , Nicole Rankin 2 , Philip Beale 2 3 , Afaf Girgis 4 , Brian Kelly 5 , Peter Grimison 6 , The ADAPT Program Group 7 , 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. Cancer Services for the Sydney Local Health District, Incorporating Royal Prince Alfred, Concord and Canterbury Hospitals,, Campsie, NSW, Australia
  4. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia
  5. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  6. Chris O'Brien Lifehouse, Sydney, NSW, Australia
  7. ADAPT Program, Group

Background

Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for anxiety and depression in cancer patients (ADAPT-CP) was implemented in 12 Australian oncology services for 12 months, within a cluster-randomised controlled trial of core versus enhanced implementation strategies. This study aimed to compare staff-perceived acceptability and appropriateness of the ADAPT-CP across study arms.

Methods

Multi-disciplinary lead teams at each service tailored, planned, championed and implemented the CP. Purposively selected staff, completed a survey and participated in an interview prior to implementation (T0), and at midpoint (6 months;T1) and end (12 months;T2) of implementation. Interviews were recorded, transcribed and thematically analysed.

Results

Seven metropolitan and 5 regional services participated. Questionnaires were completed by 106, 58 and 57 staff at T0, T1 and T2 respectively. Eighty-eight staff consented to be interviewed at T0, with 89 and 76 at T1 and T2. Acceptability/appropriateness, on the quantitative measure, was high at T0 (mean of 31/35) and remained consistent throughout the study, with no differences between arms. Perceived burden was relatively low (mean of 11/20) with no change over time. Lowest scores and greatest variability pertained to perceived impact on workload, time and cost. Four major themes were identified: 1) Mental health is an important issue which ADAPT addresses; 2) ADAPT helps staff deliver best care and reduces staff stress; 3) ADAPT is fit for purpose, for both cancer care services and patients; 4) ADAPT: a catalyst for change.

Conclusions

This study demonstrated high staff-perceived acceptability and appropriateness of the ADAPT-CP with regards to its focus, evidence-base, utility to staff and patients, and ability to create change. However, concerns remained regarding burden on staff and cost. Strategies from a policy and managerial level will likely be required to overcome the latter issues.