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

Butow, Phyllis; Shaw, Joanne; Shepherd, Heather L.; Price, Melanie A.; Masya, Lindy; Kelly, Brian; Rankin, Nicole; Girgis, Afaf; Hack, Thomas F.; Beale, Philip; Viney, Rosalie; Dhillon, Haryana M.; Coll, Joseph R.; Kelly, Patrick J.; Lovell, Melanie; Grimison, Peter; Shaw, Tim; Luckett, Tim; Cuddy, Jessica; White, Fiona A.

doi:10.1186/s12885-018-4962-9

Cited by 37 publications

(53 citation statements)

References 36 publications

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“…This real-world feasibility study was helpful in fine tuning the ADAPT Portal and implementation strategies for the subsequent cluster randomised trial, which commenced in 2017, with final data collection envisaged for 2020 [15]. Conversations about terminology, hospital processes and flow of systems allowed the facilitators and staff to develop a shared language and pre-empted some barriers during the study.…”

Section: Discussionmentioning

confidence: 99%

“…We therefore selected this approach to meet the aims of the current study and used the consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist for interviews and focus groups (see Additional file 1), to guide structure and reporting [17]. This feasibility study was designed to inform the multi-site cluster randomised trial, in which sites will be randomised to different levels of implementation support-full details of the main trial are available in the published protocol [15].…”

Section: Designmentioning

confidence: 99%

“…A core resource is the online portal (the ADAPT Portal), which systematically operationalises the ADAPT CP and carries out a range of automated processes for screening, alerts and referrals. Alongside the Portal, the ADAPT implementation strategies include awareness campaigns, academic detailing, reporting and technical support [ 15 ]. This single-site study was designed to assess the feasibility and acceptability of the ADAPT CP implementation strategies in routine clinical practice, including the ADAPT Portal, in order to refine these strategies for use during a large implementation-focused cluster randomised trial to implement the ADAPT CP in 12 cancer services across New South Wales, Australia [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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The value of real-world testing: a qualitative feasibility study to explore staff and organisational barriers and strategies to support implementation of a clinical pathway for the management of anxiety and depression in adult cancer patients

Geerligs

Shepherd

Rankin

et al. 2020

Pilot Feasibility Stud

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Background: Effective translation of evidence-based research into clinical practice requires assessment of the many factors that can impact implementation success. Research methods that draw on recognised implementation frameworks, such as the Promoting Action Research in Health Services (PARiHS) framework, and that test feasibility to gain information prior to full-scale roll-out, can support a more structured approach to implementation. Objective: This paper presents qualitative findings from a feasibility study in one cancer service of an online portal to operationalise a clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients. The aim of this study was to explore staff perspectives on the feasibility and acceptance of a range of strategies to support implementation in order to inform the full-scale roll-out. Methods: Semi-structured interviews were conducted with fifteen hospital staff holding a range of clinical, administrative and managerial roles, and with differing levels of exposure to the pathway. Qualitative data were analysed thematically, and themes were subsequently organised within the constructs of the PARiHS framework. Results: Barriers and facilitators that affected the feasibility of the online portal and implementation strategies were organised across eight key themes: staff perceptions, culture, external influences, attitudes to psychosocial care, intervention fit, familiarity, burden and engagement. These themes mapped to the PARiHS framework's three domains of evidence, context and facilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The value of real-world testing: a qualitative feasibility study to explore staff and organisational barriers and strategies to support implementation of a clinical pathway for the management of anxiety and depression in adult cancer patients

Geerligs

Shepherd

Rankin

et al. 2020

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

show abstract

“…Full descriptions of the ADAPT CP (17, 18) and the ADAPT Cluster RCT protocol (19) are reported elsewhere but brief details are provided here to give context. The ADAPT Cluster RCT is registered with the Australian New Zealand Clinical Trials Registry ACTRN12617000411347.…”

Section: Project Backgroundmentioning

confidence: 99%

The Elusive Search for Success: Defining and Measuring Implementation Outcomes in a Real-World Hospital Trial

Shepherd

Geerligs

Butow

et al. 2019

Front. Public Health

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Objective and Study Setting: Research efforts to identify factors that influence successful implementation are growing. This paper describes methods of defining and measuring outcomes of implementation success, using a cluster randomized controlled trial with 12 cancer services in Australia comparing the effectiveness of implementation strategies to support adherence to the Australian Clinical Pathway for the Screening, Assessment and Management of Anxiety and Depression in Adult Cancer Patients (ADAPT CP).Study Design and Methods: Using the StaRI guidelines, a process evaluation was planned to explore participant experience of the ADAPT CP, resources and implementation strategies according to the Implementation Outcomes Framework. This study focused on identifying measurable outcome criteria, prior to data collection for the trial, which is currently in progress.Principal Findings: We translated each implementation outcome into clearly defined and measurable criteria, noting whether each addressed the ADAPT CP, resources or implementation strategies, or a combination of the three. A consensus process defined measures for the primary outcome (adherence) and secondary (implementation) outcomes; this process included literature review, discussion and clear measurement parameters. Based on our experience, we present an approach that could be used as a guide for other researchers and clinicians seeking to define success in their work.Conclusions: Defining and operationalizing success in real-world implementation yields a range of methodological challenges and complexities that may be overcome by iterative review and engagement with end users. A clear understanding of how outcomes are defined and measured, based on a strong theoretical framework, is crucial to meaningful measurement and outcomes. The conceptual approach described in this article could be generalized for use in other studies.Trial Registration: The ADAPT Program to support the management of anxiety and depression in adult cancer patients: a cluster randomized trial to evaluate different implementation strategies of the Clinical Pathway for Screening, Assessment and Management of Anxiety and Depression in Adult Cancer Patients was prospectively registered with the Australian New Zealand Clinical Trials Registry Registration Number: ACTRN12617000411347.

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“…There is a crucial need within the field of implementation science to better understand the specific mechanisms that contribute to successful implementation of healthcare innovations. Gaining an understanding of which implementation strategies do and do not work, and at what "dose," will ideally strengthen study designs, increase uptake of innovations, and ultimately improve health outcomes [1,2]. One key strategy needing examination is facilitation, the process of aiding uptake of innovations by helping individuals and teams to understand change processes and achieve implementation goals [3].…”

Section: Introductionmentioning

confidence: 99%

External facilitators’ perceptions of internal facilitation skills during implementation of collaborative care for mental health teams: a qualitative analysis informed by the i-PARIHS framework

Connolly

Sullivan

Ritchie

et al. 2020

BMC Health Serv Res

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Background: Facilitation is a key strategy that may contribute to successful implementation of healthcare innovations. In blended facilitation, external facilitators (EFs) guide and support internal facilitators (IFs) in directing implementation processes. Developers of the i-PARIHS framework propose that successful facilitation requires project management, team/ process, and influencing/negotiating skills. It is unclear what IF skills are most important in real-world settings, which could inform recruitment and training efforts. As prior qualitative studies of IF skills have only interviewed IFs, the perspectives of their EF partners are needed. Furthermore, little is known regarding the distribution of implementation tasks between IFs and EFs, which could impact sustainability once external support is removed. In the context of an implementation trial, we therefore: 1) evaluated IFs' use of i-PARIHS facilitation skills, from EFs' perspectives; 2) identified attributes of IFs not encompassed within the i-PARIHS skills; and 3) investigated the relative contributions of IFs and EFs during facilitation. Methods: Analyses were conducted within a hybrid type II trial utilizing blended facilitation to implement the collaborative chronic care model within mental health teams of nine VA medical centers. Each site committed one team and an IF to weekly process design meetings and additional implementation activities over 12 months. Three EFs worked with three sites each. Following study completion, the EFs completed semi-structured qualitative interviews reflecting on the facilitation process, informed by the i-PARIHS facilitation skill areas. Interviews were analyzed via directed content analysis. Results: EFs emphasized the importance of IFs having strong project management, team/process, and influencing/ negotiating skills. Prior experience in these areas and a mental health background were also benefits. Personal characteristics (e.g., flexible, assertive) were described as critical, particularly when faced with conflict. EFs discussed the importance of clear delineation of EF/IF roles, and the need to shift facilitation responsibilities to IFs.

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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

Cited by 37 publications

References 36 publications

The value of real-world testing: a qualitative feasibility study to explore staff and organisational barriers and strategies to support implementation of a clinical pathway for the management of anxiety and depression in adult cancer patients

The value of real-world testing: a qualitative feasibility study to explore staff and organisational barriers and strategies to support implementation of a clinical pathway for the management of anxiety and depression in adult cancer patients

The Elusive Search for Success: Defining and Measuring Implementation Outcomes in a Real-World Hospital Trial

External facilitators’ perceptions of internal facilitation skills during implementation of collaborative care for mental health teams: a qualitative analysis informed by the i-PARIHS framework

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