Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives

Abstract Background Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for screening and management of anxiety and depression in cancer patients (the ADAPT CP) was implemented in 12 Australian oncology services for 12 ...

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Autores principales:	Phyllis Butow, Heather L. Shepherd, Jessica Cuddy, Marnie Harris, Sharon He, Lindy Masya, Mona Faris, Nicole M. Rankin, Philip Beale, Afaf Girgis, Brian Kelly, Peter Grimison, The ADAPT Program Group, Joanne Shaw
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Anxiety and depression Cancer Clinical pathway Implementation Routine care Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/3cf670388c154ee4be2f1edb5d63a9ec
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spelling	oai:doaj.org-article:3cf670388c154ee4be2f1edb5d63a9ec2021-11-21T12:06:27ZAcceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives10.1186/s12913-021-07252-z1472-6963https://doaj.org/article/3cf670388c154ee4be2f1edb5d63a9ec2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07252-zhttps://doaj.org/toc/1472-6963Abstract Background Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for screening and management of anxiety and depression in cancer patients (the ADAPT CP) was implemented in 12 Australian oncology services for 12 months, within a cluster randomised controlled trial of core versus enhanced implementation strategies. This paper compares staff-perceived acceptability and appropriateness of the ADAPT CP across study arms. Methods Multi-disciplinary lead teams at each service tailored, planned, championed and implemented the CP. Staff at participating services, purposively selected for diversity, completed a survey and participated in an interview prior to implementation (T0), and at midpoint (6 months: T1) and end (12 months: T2) of implementation. Interviews were recorded, transcribed and thematically analysed. Results Seven metropolitan and 5 regional services participated. Questionnaires were completed by 106, 58 and 57 staff at T0, T1 and T2 respectively. Eighty-eight staff consented to be interviewed at T0, with 89 and 76 at T1 and T2 (response rates 70%, 66% and 57%, respectively). Acceptability/appropriateness, on the quantitative measure, was high at T0 (mean of 31/35) and remained at that level throughout the study, with no differences between staff from core versus enhanced services. Perceived burden was relatively low (mean of 11/20) with no change over time. Lowest scores and greatest variability pertained to perceived impact on workload, time and cost. Four major themes were identified: 1) Mental health is an important issue which ADAPT addresses; 2) ADAPT helps staff deliver best care, and reduces staff stress; 3) ADAPT is fit for purpose, for both cancer care services and patients; 4) ADAPT: a catalyst for change. Opposing viewpoints are outlined. Conclusions This study demonstrated high staff-perceived acceptability and appropriateness of the ADAPT CP with regards to its focus, evidence-base, utility to staff and patients, and ability to create change. However, concerns remained regarding burden on staff and time commitment. Strategies from a policy and managerial level will likely be required to overcome the latter issues. Trial registration The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/ .Phyllis ButowHeather L. ShepherdJessica CuddyMarnie HarrisSharon HeLindy MasyaMona FarisNicole M. RankinPhilip BealeAfaf GirgisBrian KellyPeter GrimisonThe ADAPT Program GroupJoanne ShawBMCarticleAnxiety and depressionCancerClinical pathwayImplementationRoutine carePublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Anxiety and depression Cancer Clinical pathway Implementation Routine care Public aspects of medicine RA1-1270
spellingShingle	Anxiety and depression Cancer Clinical pathway Implementation Routine care Public aspects of medicine RA1-1270 Phyllis Butow Heather L. Shepherd Jessica Cuddy Marnie Harris Sharon He Lindy Masya Mona Faris Nicole M. Rankin Philip Beale Afaf Girgis Brian Kelly Peter Grimison The ADAPT Program Group Joanne Shaw Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
description	Abstract Background Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for screening and management of anxiety and depression in cancer patients (the ADAPT CP) was implemented in 12 Australian oncology services for 12 months, within a cluster randomised controlled trial of core versus enhanced implementation strategies. This paper compares staff-perceived acceptability and appropriateness of the ADAPT CP across study arms. Methods Multi-disciplinary lead teams at each service tailored, planned, championed and implemented the CP. Staff at participating services, purposively selected for diversity, completed a survey and participated in an interview prior to implementation (T0), and at midpoint (6 months: T1) and end (12 months: T2) of implementation. Interviews were recorded, transcribed and thematically analysed. Results Seven metropolitan and 5 regional services participated. Questionnaires were completed by 106, 58 and 57 staff at T0, T1 and T2 respectively. Eighty-eight staff consented to be interviewed at T0, with 89 and 76 at T1 and T2 (response rates 70%, 66% and 57%, respectively). Acceptability/appropriateness, on the quantitative measure, was high at T0 (mean of 31/35) and remained at that level throughout the study, with no differences between staff from core versus enhanced services. Perceived burden was relatively low (mean of 11/20) with no change over time. Lowest scores and greatest variability pertained to perceived impact on workload, time and cost. Four major themes were identified: 1) Mental health is an important issue which ADAPT addresses; 2) ADAPT helps staff deliver best care, and reduces staff stress; 3) ADAPT is fit for purpose, for both cancer care services and patients; 4) ADAPT: a catalyst for change. Opposing viewpoints are outlined. Conclusions This study demonstrated high staff-perceived acceptability and appropriateness of the ADAPT CP with regards to its focus, evidence-base, utility to staff and patients, and ability to create change. However, concerns remained regarding burden on staff and time commitment. Strategies from a policy and managerial level will likely be required to overcome the latter issues. Trial registration The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/ .
format	article
author	Phyllis Butow Heather L. Shepherd Jessica Cuddy Marnie Harris Sharon He Lindy Masya Mona Faris Nicole M. Rankin Philip Beale Afaf Girgis Brian Kelly Peter Grimison The ADAPT Program Group Joanne Shaw
author_facet	Phyllis Butow Heather L. Shepherd Jessica Cuddy Marnie Harris Sharon He Lindy Masya Mona Faris Nicole M. Rankin Philip Beale Afaf Girgis Brian Kelly Peter Grimison The ADAPT Program Group Joanne Shaw
author_sort	Phyllis Butow
title	Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
title_short	Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
title_full	Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
title_fullStr	Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
title_full_unstemmed	Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
title_sort	acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
publisher	BMC
publishDate	2021
url	https://doaj.org/article/3cf670388c154ee4be2f1edb5d63a9ec
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Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives

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