Individual Abstract within a Delegate Designed Symposium Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Adherence to a clinical pathway for anxiety and depression in cancer patients in routine care; impact of core versus enhanced implementation strategies. (#71)

Phyllis N Butow 1 , Heather L Shepherd 1 2 , Mona Faris 1 , Patrick Kelly 3 , The ADAPT Program Group 1 , Joanne M Shaw 1
  1. Psycho-oncology Cooperative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, NSW, Australia
  2. Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
  3. Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, The University of Sydney, NSW, Australia

Introduction: The ADAPT-CP to guide screening, assessment and management of anxiety and depression in adult cancer patients is based on evidence review  and refined through comprehensive stakeholder review and a Delphi consensus process1,2. The ADAPT-CP follows a stepped care model incorporating iterative screening at recommended intervals, with triage to one of five steps, each with a recommended management plan for those with minimal or mild levels of anxiety and/or depression, to specialist care for those with severe anxiety and/or depression), with review and change in step where necessary.

Aims: The ADAPT Cluster RCT3 evaluated the level of implementation support required (core versus enhanced) to achieve adherence to the ADAPT CP over a 12-month period.  

Methods:  We developed resources and implementation strategies guided by the Promoting Action Research in Health Services (PARiHS) framework4 . We specified adherence as the percentage of all CP components (such as screening, triage, referral and re-screening) appropriate to the patient’s level of anxiety and depression to provide a site-level adherence score of 0-100.  To provide a more clinically relevant measure of adherence, we further defined a categorical outcome (adherent: ≥70% of patients experienced ≥70% of key ADAPT-CP components (e.g. screening, triage, referral and re-screening); or non-adherent: <70% of patients experienced ≥70% of key ADAPT-CP components, based on accepted implementation targets.

Results: While adherence did not differ significantly between implementation arms, there was a trend toward differences between implementations arms with greater adherence to the clinical pathway for patients scoring high on clinical levels of distress in enhanced compared to core services.

Conclusions: The findings from this study confirm cancer services require additional support when implementing practice change related to more complex clinical decisions such as management of clinical anxiety and/or depression.

  1. Butow P, et al. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psycho-Oncology. 2015;24(9):987–1001.
  2. Shaw JM, et al. Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process. Support Care Cancer. 2015;24(1):33-41.
  3. Butow, P., Shaw, J., Shepherd, H. L., et al (2018). Comparison of implementation strategies to influence adherence to the clinical pathway for screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP): study protocol of a cluster randomised controlled trial. BMC cancer, 18(1), 1077. https://doi.org/10.1186/s12885-018-4962-9
  4. Kitson, A.L., Rycroft-Malone, J., Harvey, G. et al. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implementation Sci 3, 1 (2008). https://doi.org/10.1186/1748-5908-3-1