Impact of Individual, Organizational, and Technological Factors on the Implementation of an Online Portal to Support a Clinical Pathway Addressing Psycho-Oncology Care: Mixed Methods Study

Abstract

Background Clinical pathways (CPs) can improve patient outcomes but can be complex to implement. Technologies, such as clinical decision support (CDS) tools, can facilitate their use, but require end-user testing in clinical settings. Objective This study applied the Technology Acceptance Model to evaluate the individual, organizational, and technological contexts impacting application of a portal to facilitate a CP for anxiety and depression (the ADAPT Portal) in a metropolitan cancer service. The ADAPT Portal triggers patient screening on patient reported outcomes, alerts staff to high scores, recommends evidence-based management, and triggers review and rescreening at set intervals. Methods Quantitative and qualitative data on portal activity, data accuracy, and health service staff perspectives were collected. Quantitative data were analyzed descriptively, and thematic analysis was applied to qualitative data. Results Overall, 15 (100% of those invited) health service staff agreed to be interviewed. During the pilot, 73 users (36 health service staff members and 37 patients) were registered on the ADAPT Portal. Of the 37 patients registered, 16 (43%) completed screening at least once, with seven screening positive and triaged appropriately. In total, 34 support requests were lodged, resulting in 17 portal enhancements (technical issues). Health service staff considered the ADAPT Portal easy to use and useful; however, some deemed it unnecessary or burdensome (individual issues), particularly in a busy cancer service (organizational issues). Conclusions User testing of a CDS to facilitate screening and assessment of anxiety and depression in cancer patients highlighted some technological issues in implementing the ADAPT CDS, resulting in 17 enhancements. Our results highlight the importance of obtaining health service staff feedback when piloting specialized CDS tools and addressing contextual factors when implementing them.

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

“…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 ]. The large variance in the time taken to use the portal by nurses may reflect a range of factors including the digital health literacy of the nurses, familiarity with the screening process and possibly the perception of time spent as the reporting was subjective.…”

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

“…12 Nepean Cancer Centre, NSW, Australia. 13 Northern Clinical School, Faculty of Medicine and Health, The University of Sydney,…”

“…The ADAPT CP provides evidence-based recommendations on appropriate staffing, and the content and timing of interventions for each step [11]. Resources were developed to support the CP, including an online portal [13] to operationalise and standardise as many processes as possible, to increase efficiency and minimise staff time and burden, as well as staff and patient education materials, accessible via the portal.…”

Staff perspectives on the feasibility of a clinical pathway for anxiety and depression in cancer care, and mid-implementation adaptations

“…Recommendations regarding staff roles, and content and timing of interventions, are provided for each step [ 18 ]. To facilitate CP implementation, we developed staff and patient education resources, and an online portal [ 21 ] to operationalise processes, increase efficiency and reduce staff time and burden.…”