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

Abstract

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.

Conceptual and relational advances of the PARIHS and i-PARIHS frameworks over the last decade: a critical interpretive synthesis

“…External organizations include entities developing evidence-based guidelines, and entities promoting and funding implementation of evidence-based guidelines. Sandstrom et al (2015) [ 17 ] a Geerligs et al (2020) [ 19 ] a Societal culture, social systems, or hegemony Note. Particularly relevant in implementation of public health interventions Niemeyer Hultstrand et al (2020) [ 18 ] b Conceptualization of leadership Leadership as a social collective process that has dynamic relationships with team culture, is characterized by diversified styles and diverse actions and operates in multiple ways and on multiple levels in the organization.…”

“…Note. Particularly applicable when implementing a specific targeted evidence-based practice or clinical intervention Stetler et al (2010) [ 26 ] a ; Geerligs et al (2020) [ 19 ] a ; Butow et al (2019) [ 29 ] a Facilitation as specific facilitative actions and strategies: Steffen et al (2021) [ 33 ] b • Plan strategies • Educate strategies • Quality management strategies • Other strategies Note. The authors detail specific facilitative actions under each category of strategies Holistic-oriented facilitation: • Creating a psychologically safe space • Establishing capacity-building mentoring relationships Note.…”

“…Six empirical articles proposed conceptualizations of outer/external context [ 17 – 22 ]. Emphases on sub-elements of outer/external context depended on implementation contexts, such as external resources (abundance or scarcity) in low-income healthcare settings [ 22 ]; capacity of researchers, clinicians, and other stakeholders for integrated knowledge translation programs [ 20 ]; societal culture for implementing public health interventions [ 18 ]; credibility of external entities responsible for developing or promoting clinical guidelines to implement a specific clinical guideline [ 17 , 19 ]; and social networks and communication pathways with external entities in sectors such as the construction industry, where lines of information-sharing were fragmented and multidirectional [ 21 ].…”

“…Articles extended the conceptualization of facilitation as roles, processes, or strategies that facilitate the achievement of implementation goals [ 19 , 26 – 34 ]. Among articles focusing on facilitation processes or strategies, three suggested facilitation as a deliberate implementation intervention targeting evidence–context fit [ 19 , 26 , 29 ].…”

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

“…Interviews were transcribed for analysis. Additional data from the staff interviews focusing on staff and organizational barriers to utilizing the ADAPT CP are published elsewhere [ 25 ]. The ADAPT research team also recorded extensive field observations after each user support contact with staff as well as during meetings with the lead team during the implementation process to record issues raised and resolutions reached.…”