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

How the implementation of the ADAPT Clinical Pathway played out for staff, services and patients (#70)

Heather L Shepherd 1 2 , Phyllis Butow 1 , Joanne Shaw 1 , Mona Faris 1 , Sharon He 1 , Marnie Harris 1 , Patrick Kelly 3 , Jessica Cuddy 1 , Nicole Rankin 1 4 , Peter Grimison 5 , Philip Beale 6 , Afaf Girgis 1 7 , Lindy Masya 1 , Brian Kelly 1 8 , The ADAPT Program Group 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
  4. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  5. Chris O'Brien Lifehouse, Sydney, NSW, Australia
  6. Royal Prince Alfred Hospital, SLHD, Camperdown, NSW, Australia
  7. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia
  8. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

Background: This study investigated perceptions of the implementation of the ADAPT clinical pathway (ADAPT-CP) and how the ADAPT-CP was adopted by health service staff and patients.

Methods: Within the ADAPT Cluster RCT1 staff completed interviews and surveys prior to implementation, at midpoint, and implementation end. Monthly meetings with service lead teams in the enhanced arm services were recorded. Interview transcripts and meeting notes were thematically analysed.  As part of routine care patients completed a brief screening tool with problem list within a web-based portal, and where distress was high, the Hospital Anxiety and Depression Scale, usually 3-monthly, over 12-months.

Results: Staff perceived the-ADAPT CP of high value, but timing of screening was difficult, online screening was challenging and burdensome particularly when referral pathways were less assured. Staff perceptions were high on the acceptability/appropriateness of the ADAPT-CP, helping staff deliver evidence-based care, fit for purpose for services and patients, with the ADAPT-CP implementation viewed as a catalyst for change. Surveys indicated that acceptability/appropriateness was high throughout, regardless or study arm (core versus enhanced).

696 patients were registered and screened (1,323 screening events), with two-thirds screening multiple times. There was a significant reduction in distress levels from initial to subsequent screens. 8,645 problems were reported, the most common being emotional (27-34%) and physical (19-22%). Most psychosocial referrals were made to social work or counselling for lower anxiety/depression scores, and to psychology and psychiatry for mild, moderate, or severe anxiety and depression.

Conclusions: Staff respond to patient needs according to available resources and pre-existing referral pathways and actively engage with and adapt to implementation challenges. However, concerns remained regarding staff burden and time commitment. Policy and management strategies may overcome the latter. From a patient perspective, regular screening identified new or persistent problems and potential clinical levels of anxiety and depression.

  1. 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