- Title
- Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives
- Creator
- Butow, Phyllis; Shepherd, Heather L.; Cuddy, Jessica; Harris, Marnie; He, Sharon; Masya, Lindy; Faris, Mona; Rankin, Nicole M.; Beale, Philip; Girgis, Afaf; Kelly, Brian; Grimison, Peter; The ADAPT Program Group,; Shaw, Joanna
- Relation
- BMC Health Services Research Vol. 21, no. 1243
- Publisher Link
- http://dx.doi.org/10.1186/s12913-021-07252-z
- Publisher
- BioMed Central (BMC)
- Resource Type
- journal article
- Date
- 2021
- Description
- 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.
- Subject
- anxiety and depression; cancer; clinical pathway; implementation; routine care; SDG 3; SDG 10; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1437227
- Identifier
- uon:40280
- Identifier
- ISSN:1472-6963
- Language
- eng
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