Background: Addressing the needs of carers of people with advanced cancer is not standard practice in hospital oncology settings. The CSNAT-Intervention (CSNAT-I) identifies and addresses carers personal and practical needs. A 12-month multi-site project provided an opportunity for acute occupational therapists to embed the CSNAT-I into their practice. This was supported by a suite of implementation strategies that targeted behavioural and organisational factors. The aim of this project was to describe process and behavioural change strategies used to implement the CSNAT-I into usual practice.
Method: A CSNAT-I training and implementation toolkit and a behaviour change framework informed the development and application of implementation strategies across all stages of the project. Evaluation of the success of these strategies are reported in an another paper.
Results: In response to focus group and stakeholder engagement, most strategies occurred at the clinician and consumer levels; targeting pre-conceived beliefs about the importance of carer needs in discharge planning and clinicians' scope to address these. Intervention strategies included (1) education via structured training, reflective practice sessions, and peer modelling; (2) environmental restructuring via guideline development and use of electronic medical record, (3) enablement via project and clinical leads; and (4) persuasion via consumer participation, peer modelling and feedback loops. The delivery of these strategies was an iterative process that changes according to evaluation data obtained along the way.
Conclusion: A toolkit approach can support implementation of a person-centred intervention like the CSNAT-I, but it requires supplementation by education and feedback techniques which are adapted to local context and iteratively over time to adequately target behaviour change relevant to the individual clinician, and the work environment.