From ideal to actual practice: Tailoring a clinical pathway to address anxiety or depression in patients with cancer and planning its implementation across individual clinical services

Butow, Phyllis; Shepherd, Heather L.; Cuddy, Jessica; Harris, Margaret; He, Sharon; Rankin, Nicole; Grimison, Peter; Girgis, Afaf; Shaw, Joanne

doi:10.1097/or9.0000000000000061

Cited by 10 publications

(11 citation statements)

References 38 publications

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“…This awareness of the tension between feasibility and optimal care suggests that models of care need to be flexible and tailored to the particular service context -what is feasible in one cancer care service may not be feasible in another, a concept widely recognised and reported in implementation frameworks and studies. 28,29 Consideration needs to be given to workload and changed work practices required in the local context; availability of psychooncology and social work services on and offsite; and whether staff role descriptions and responsibilities incorporate tasks required within the intervention or are amenable to adaptation. Intervention flexibility, carefully and systematically planned in a process involving stakeholders 30,31 is widely endorsed to accommodate context and ensure sustainability, but must be done carefully to avoid compromising validity and outcomes.…”

Section: Tension As a Meta-themementioning

confidence: 99%

Promise unfulfilled: Implementing web‐based psychological therapy in routine cancer care, a qualitative study of oncology health professionals’ attitudes

et al. 2022

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Background: Web-based mental health interventions (e-MhIs) show promise for increasing accessibility and acceptability of therapy for cancer patients.Aim: This study aimed to elicit health professionals' (HPs) views on optimal models for including e-MhIs within standard cancer care. Materials & Method:Cancer HPs who worked in a service where an e-MhI was available to patients, and multi-disciplinary HPs interested in supportive care, were invited to participate via email. In semi-structured phone interviews, participants' views on e-MhIs were elicited. They were then presented with five model vignettes varying in local and centralised staff input, and asked to indicate their preference and views on each. A thematic analysis was applied to the data.Results: Twelve nurses, nine psychologists, seven social workers, and three oncologists participated. Four key themes were identified: looking after patients, relationships and multidisciplinary care, trust, and feasibility, all contributing to a meta-theme of tension. Participants were motivated to ensure optimal patient outcomes and thus needed to trust the intervention content and process. They believed personal relationships increased patient engagement while affording greater work satisfaction for HPs. Most participants preferred a fully integrated model of care involving local HP assessment and design of a tailored therapy incorporating some e-MhI components where appropriate, but recognised this gold standard was likely not feasible given current resources. Discussion and Conclusion:Co-design with local staff of optimal models of care for the content and process of implementing e-MhIs is required, with due consideration of the patient group, staffing levels, local workflows and HP preferences, to ensure sustainability and optimal patient outcomes.

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Section: Tension As a Meta-themementioning

confidence: 99%

Promise unfulfilled: Implementing web‐based psychological therapy in routine cancer care, a qualitative study of oncology health professionals’ attitudes

et al. 2022

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“…Among the 23 studies in our review, the only exception to this is Butow et al's ADAPT Program Group, 51 who recently published additional papers detailing their implementation strategy development and evaluation. 51,75–83 This study provides a useful example and signals that the use of implementation methods in the field is slowly changing. Researchers should continue to carefully consider the design of implementation strategies, using recommended methods 26,42,84 and frameworks 38 to systematically plan, test and report implementation strategies.…”

Section: Discussionmentioning

confidence: 96%

Implementation of digital health interventions in rehabilitation: A scoping review

et al. 2023

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Objective Digital health interventions have potential to enhance rehabilitation services by increasing accessibility, affordability and scalability. However, implementation of digital interventions in rehabilitation is poorly understood. This scoping review aims to map current strategies, research designs, frameworks, outcomes and determinants used to support and evaluate the implementation of digital interventions in rehabilitation. Data sources Comprehensive searches from inception until October 2022 of MEDLINE, CINAHL, PsycINFO, PEDro, SpeechBITE, NeuroBITE, REHABDATA, WHO International Clinical Trial Registry and the Cochrane Library. Methods Two reviewers screened studies against the eligibility criteria. Implementation science taxonomies and methods, including Powell et al.'s compilation of implementation strategies, were used to guide analysis and synthesis of findings. Results The search retrieved 13,833 papers and 23 studies were included. Only 4 studies were randomised controlled trials and 9 studies (39%) were feasibility studies. Thirty-seven discrete implementation strategies were reported across studies. Strategies related to training and educating clinicians (91%), providing interactive assistance (61%), and developing stakeholder interrelationships (43%) were most frequently reported. Few studies adequately described implementation strategies and methods for selecting strategies. Almost all studies measured implementation outcomes and determinants; most commonly, acceptability, compatibility and dose delivered of digital interventions. Conclusion The rigour of implementation methods in the field is currently poor. Digital interventions require carefully planned and tailored implementation to facilitate successful adoption into rehabilitation practice. To keep pace with rapidly advancing technology, future rehabilitation research should prioritise using implementation science methods to explore and evaluate implementation while testing effectiveness of digital interventions.

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“…when cancer diagnosis had just occurred) as symptoms, especially distress, may be transient and spontaneously resolve. These findings suggest further training on the purpose, and benefits of screening would be required to increase uptake as well as clear clinical pathways clarifying roles and responsibilities and embedding screening into the routine workflow [ 15 ]. These observations are similar to the implementation of the ADAPT portal on which the iSCREEN portal was based [ 16 , 17 ] and other studies investigating PRO use in cancer care [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Implementing a web-based system of screening for symptoms and needs using patient-reported outcomes in people with cancer

Koczwara

Knowles

Beatty

et al. 2022

Support Care Cancer

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Purpose To evaluate the implementation of a web-based system of screening for symptoms and needs in people with diverse cancers in a general hospital in Australia. Methods This was a prospective, single-arm, pragmatic intervention study. After local adaptation of an online portal and training, cancer nurses were asked to register patients to screen via the portal in clinic or at home. Symptoms were scored according to severity, and scores above cut-off were reported to nurses for assessment and management, according to best practice. Results Fifteen nurses working across diverse tumour types agreed to approach patients for screening. Of these, 7 nurses approached 68 patients, with 5 approaching more than 1 during the 7-month study period. Forty-seven (69%) patients completed screening, and 22 rescreened at least once. At first screening, 33 (70%) patients reported at least one symptom, most commonly tiredness ( n = 27; 57%), reduced wellbeing ( n = 24; 51%) and drowsiness ( n = 17; 36%). Of the total 75 screens undertaken during the study, 56 (75%) identified at least one symptom, and 22 (29%) identified at least one severe symptom. All patients with a positive first screen were followed up by a nurse assessment and intervention—mostly reassurance ( n = 19, 59%) or referral to another health professional ( n = 11, 34%). Conclusion Screening for symptoms and needs using a web-based portal identified many unmet needs, but the uptake of this intervention by nurses and patients was lower than expected.

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From ideal to actual practice: Tailoring a clinical pathway to address anxiety or depression in patients with cancer and planning its implementation across individual clinical services

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 38 publications

Promise unfulfilled: Implementing web‐based psychological therapy in routine cancer care, a qualitative study of oncology health professionals’ attitudes

Promise unfulfilled: Implementing web‐based psychological therapy in routine cancer care, a qualitative study of oncology health professionals’ attitudes

Implementation of digital health interventions in rehabilitation: A scoping review

Implementing a web-based system of screening for symptoms and needs using patient-reported outcomes in people with cancer

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