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

Uptake of an online psychological therapy program (iCanADAPT-Early) when implemented within a Clinical Pathway in routine cancer care. (#205)

Fiona Davies 1 , Marnie Harris 1 , Joanne Shaw 1 , Phyllis Butow 1 , Jill Newby 2 3 , Michael Murphy 3 , Laura Kirsten 4 , The ADAPT Program Group 5 , Heather Shepherd 1 6
  1. School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
  2. School of Psychology, Faculty of Science , UNSW, Sydney, NSW, Australia
  3. Clinical Research Unit for Anxiety and Depression, UNSW, Sydney, NSW , Australia
  4. Nepean Cancer Centre , NSW, Australia
  5. ADAPT Program, Group
  6. Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney , Sydney, NSW, Australia

Background

Despite increased focus on cancer patients’ psychosocial well-being, there are barriers to access and uptake of psychosocial support. Online cognitive behavioural therapy (CBT) programs can address many barriers, yet evidence for their efficacy is mixed and very little research has examined uptake in routine care. A clinician-monitored online CBT program for patients with early-stage cancer (iCanADAPT-Early) was developed to support implementation of a clinical pathway for anxiety/depression in cancer patients (ADAPT CP).  Staff could refer patients with mild to moderate anxiety/depression to iCanADAPT-Early, based on ADAPT CP screening score and clinical recommendation, or patients could self-refer. The aim of this study was to report uptake of iCanADAPT-Early and staff reported barriers.

Methods

ADAPT Portal screening events and referrals made by staff to iCanADAPT-Early for patients with mild to moderate anxiety/depression were collated, as well as information on patients who registered with iCanADAPT-Early and completed lessons. Semi-structured telephone interviews (n=13) were conducted with staff familiar with the program. Interviews were recorded, transcribed and thematically analysed.

Results

Of 324 screening events which indicated mild/moderate levels of anxiety/depression, only seven (2%) referrals were made by staff to iCanADAPT-Early, none of which were taken up by patients. Twenty-five patients self-referred to iCanADAPT-Early, however only seven (28%) matched the recommended anxiety/depression level for iCanADAPT-Early (most had minimal anxiety/depression). Patient engagement in iCanADAPT-Early was low, with 11/25 (44%) patients completing at least one lesson. Cancer care professionals reported numerous barriers to referral and engagement such as lack of program familiarity and patient fatigue.

Conclusions

Despite a successful efficacy study and initial enthusiasm for iCanADAPT-Early, referral, uptake and engagement with the program was low and did not always align with recommended clinical criteria. Co-design of online therapy implementation models with relevant stakeholders may help to overcome the latter issues.