Background
Online resources for patients and health professionals (HPs) were developed to support implementation of the ADAPT CP. These resources included a five module HP education program to support staff communication and confidence with anxiety/depression screening and referral and an online Cognitive Behavioral Therapy (CBT) program for patients with early-stage cancer (iCanADAPT-Early). We report the acceptability and uptake of the HP education program and the iCanADAPT-Early program.
Methods
In this study we assessed real world acceptability and uptake of the education program across the 12 oncology services participating in the ADAPT Cluster RCT and assessed the number of patient referrals made to iCanADAPT-Early, patient registrations and completion data. Qualitative interviews were also conducted with staff to explore barriers and enablers to use of these online resources.
Results
During the ADAPT Cluster RCT uptake of the HP education program was low (7%; n=20). Although those who accessed the training reported it to be valuable, competing mandatory training demands and for some, the online format, limited capacity and willingness to undertake training. Of 324 screening events which indicated mild/moderate anxiety/depression, only seven (2%) referrals were made by staff to iCanADAPT-Early. Of the patients who self referred (n=25) only 44% (n=11) completed at least one lesson and 28% (n=7) reported anxiety/depression symptoms. Staff reported lack of program familiarity as a barrier to referral and perceived the lack of patient engagement was related to patient fatigue.
Conclusion
Despite the HP education program being acceptable during pilot-testing and initial enthusiasm for iCanADAPT-Early, there was low uptake in real world settings. This highlights organisational support and incentivisation for front line staff to undertake training is critical for wider engagement. Co-design of online therapy implementation models with relevant stakeholders may help to overcome knowledge and engagement barriers