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

From ideal to actual practice: Tailoring a clinical pathway to address anxiety or depression in patients with cancer and planning its implementation across individual clinical services (#296)

Phyllis Butow 1 , Heather Shepherd 1 2 , Jessica Cuddy 1 , Marnie Harris 1 , Sharon He 1 , Lindy Masya 1 , Nicole Rankin 2 , Peter Grimison 3 , Afaf Girgis 4 , 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) can improve health outcomes, but evidence of their impact is mixed, perhaps due to variations in CP delivery. Identifying why variations occur and their intended purpose is important to guide CP development and implementation. We developed a CP for anxiety and depression in cancer patients (ADAPT CP) and implemented it in 12 Oncology services in NSW that were participating in the ADAPT cluster-randomised controlled trial, allowing some tailoring of the CP for local conditions. The aim was to describe decisions and rationale for tailoring the ADAPT CP in these services.

Method

At each service, a multi-disciplinary lead team was formed to make decisions about local tailoring and to plan, champion and implement the CP. Detailed notes taken during engagement meetings, and service-specific workflow diagrams, form the data for this analysis. Notes were content-analysed, and workflows reviewed, to identify decision-making themes.

Results

Of the 12 cancer services (7 metropolitan and 5 regional), 10 were publicly funded, one was a public/private partnership, and one was privately funded. Diverse decisions were made regarding the selection of eligible patient cohorts, how to introduce screening to patients, and screening and triage processes. Rationales for decisions included aligning with existing workflows, utilizing staff with required skills, minimizing staff burden, ensuring no patient was missed, and minimizing patient distress.

Discussion

Practical issues and staff attitudes and skills often guided CP decisions, highlighting the need to work collaboratively with health services to determine the optimal workflow for each setting. While it is yet to be determined whether some decisions were optimal relating to patient outcomes, local tailoring ensured the CP became operational at all services. Allowing time and ensuring the right people are involved are essential when tailoring new CPs prior to implementation into clinical care.