Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial.

Butow, P; Faris, MM; Shaw, J; Kelly, P; He, S; Harris, M; Cuddy, J; Masya, L; Geerligs, L; Kelly, B; Girgis, A; Rankin, N; Beale, P; Hack, TF; Kirsten, L; Dhillon, H; Grimison, P; Viney, R; Clayton, JM; Schlub, T; ADAPT Program Group,; Shepherd, HL

Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial.

Butow, P Faris, MM Shaw, J Kelly, P He, S Harris, M Cuddy, J Masya, L Geerligs, L Kelly, B Girgis, A Rankin, N Beale, P Hack, TF Kirsten, L Dhillon, H Grimison, P Viney, R

Clayton, JM Schlub, T ADAPT Program Group, Shepherd, HL

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Publisher:: Springer Nature
Publication Type:: Journal Article
Citation:: Implement Sci, 2023, 18, (1), pp. 18
Issue Date:: 2023-05-22

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Field	Value	Language
dc.contributor.author	Butow, P
dc.contributor.author	Faris, MM
dc.contributor.author	Shaw, J
dc.contributor.author	Kelly, P
dc.contributor.author	He, S
dc.contributor.author	Harris, M
dc.contributor.author	Cuddy, J
dc.contributor.author	Masya, L
dc.contributor.author	Geerligs, L
dc.contributor.author	Kelly, B
dc.contributor.author	Girgis, A
dc.contributor.author	Rankin, N
dc.contributor.author	Beale, P
dc.contributor.author	Hack, TF
dc.contributor.author	Kirsten, L
dc.contributor.author	Dhillon, H
dc.contributor.author	Grimison, P
dc.contributor.author	Viney, R https://orcid.org/0000-0002-0039-9635
dc.contributor.author	Clayton, JM
dc.contributor.author	Schlub, T
dc.contributor.author	ADAPT Program Group,
dc.contributor.author	Shepherd, HL
dc.date.accessioned	2023-09-14T23:37:07Z
dc.date.available	2023-04-03
dc.date.available	2023-09-14T23:37:07Z
dc.date.issued	2023-05-22
dc.identifier.citation	Implement Sci, 2023, 18, (1), pp. 18
dc.identifier.issn	1748-5908
dc.identifier.issn	1748-5908
dc.identifier.uri	http://hdl.handle.net/10453/172102
dc.description.abstract	BACKGROUND: Optimal strategies to facilitate implementation of evidence-based clinical pathways are unclear. We evaluated two implementation strategies (Core versus Enhanced) to facilitate implementation of a clinical pathway for the management of anxiety and depression in cancer patients (the ADAPT CP). METHODS: Twelve cancer services in NSW Australia were cluster randomised, stratified by service size, to the Core versus Enhanced implementation strategy. Each strategy was in place for 12 months, facilitating uptake of the ADAPT CP (the intervention being implemented). The Core strategy included a lead team with champions, staff training and awareness campaigns prior to implementation, plus access to feedback reports and telephone or online support during implementation. The Enhanced strategy included all Core supports plus monthly lead team meetings, and proactive, ongoing advice on managing barriers, staff training and awareness campaigns throughout implementation. All patients at participating sites were offered the ADAPT CP as part of routine care, and if agreeable, completed screening measures. They were allocated a severity step for anxiety/depression from one (minimal) to five (severe) and recommended management appropriate to their severity step. Multi-level mixed-effect regression analyses examined the effect of Core versus Enhanced implementation strategy on adherence to the ADAPT CP (binary primary outcome: adherent ≥ 70% of key ADAPT CP components achieved versus non-adherent < 70%), with continuous adherence as a secondary outcome. Interaction between study arm and anxiety/depression severity step was also explored. RESULTS: Of 1280 registered patients, 696 (54%) completed at least one screening. As patients were encouraged to re-screen, there were in total 1323 screening events (883 in Core and 440 in Enhanced services). The main effect of implementation strategy on adherence was non-significant in both binary and continuous analyses. Anxiety/depression step was significant, with adherence being higher for step 1 than for other steps (p = 0.001, OR = 0.05, 95% CI 0.02-0.10). The interaction between study arm and anxiety/depression step was significant (p = 0.02) in the continuous adherence analysis only: adherence was significantly higher (by 7.6% points (95% CI 0.08-15.1%) for step 3 in the Enhanced arm (p = .048) and trending to significance for step 4. DISCUSSION: These results support ongoing implementation effort for the first year of implementation to ensure successful uptake of new clinical pathways in over-burdened clinical services. TRIAL REGISTRATION: ANZCTR Registration: ACTRN12617000411347 (Trial registered 22/03/2017; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true ).
dc.format	Electronic
dc.language	eng
dc.publisher	Springer Nature
dc.relation.ispartof	Implement Sci
dc.relation.isbasedon	10.1186/s13012-023-01269-0
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.rights	© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data
dc.subject	08 Information and Computing Sciences, 11 Medical and Health Sciences
dc.subject.classification	Health Policy & Services
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	52 Psychology
dc.subject.mesh	Humans
dc.subject.mesh	Critical Pathways
dc.subject.mesh	Depression
dc.subject.mesh	Anxiety
dc.subject.mesh	Anxiety Disorders
dc.subject.mesh	Neoplasms
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Depression
dc.subject.mesh	Anxiety
dc.subject.mesh	Anxiety Disorders
dc.subject.mesh	Critical Pathways
dc.subject.mesh	Humans
dc.subject.mesh	Critical Pathways
dc.subject.mesh	Depression
dc.subject.mesh	Anxiety
dc.subject.mesh	Anxiety Disorders
dc.subject.mesh	Neoplasms
dc.title	Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial.
dc.type	Journal Article
utslib.citation.volume	18
utslib.location.activity	England
utslib.for	08 Information and Computing Sciences
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	open_access	*
dc.date.updated	2023-09-14T23:37:03Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	18
utslib.citation.issue	1

Abstract:

BACKGROUND: Optimal strategies to facilitate implementation of evidence-based clinical pathways are unclear. We evaluated two implementation strategies (Core versus Enhanced) to facilitate implementation of a clinical pathway for the management of anxiety and depression in cancer patients (the ADAPT CP). METHODS: Twelve cancer services in NSW Australia were cluster randomised, stratified by service size, to the Core versus Enhanced implementation strategy. Each strategy was in place for 12 months, facilitating uptake of the ADAPT CP (the intervention being implemented). The Core strategy included a lead team with champions, staff training and awareness campaigns prior to implementation, plus access to feedback reports and telephone or online support during implementation. The Enhanced strategy included all Core supports plus monthly lead team meetings, and proactive, ongoing advice on managing barriers, staff training and awareness campaigns throughout implementation. All patients at participating sites were offered the ADAPT CP as part of routine care, and if agreeable, completed screening measures. They were allocated a severity step for anxiety/depression from one (minimal) to five (severe) and recommended management appropriate to their severity step. Multi-level mixed-effect regression analyses examined the effect of Core versus Enhanced implementation strategy on adherence to the ADAPT CP (binary primary outcome: adherent ≥ 70% of key ADAPT CP components achieved versus non-adherent < 70%), with continuous adherence as a secondary outcome. Interaction between study arm and anxiety/depression severity step was also explored. RESULTS: Of 1280 registered patients, 696 (54%) completed at least one screening. As patients were encouraged to re-screen, there were in total 1323 screening events (883 in Core and 440 in Enhanced services). The main effect of implementation strategy on adherence was non-significant in both binary and continuous analyses. Anxiety/depression step was significant, with adherence being higher for step 1 than for other steps (p = 0.001, OR = 0.05, 95% CI 0.02-0.10). The interaction between study arm and anxiety/depression step was significant (p = 0.02) in the continuous adherence analysis only: adherence was significantly higher (by 7.6% points (95% CI 0.08-15.1%) for step 3 in the Enhanced arm (p = .048) and trending to significance for step 4. DISCUSSION: These results support ongoing implementation effort for the first year of implementation to ensure successful uptake of new clinical pathways in over-burdened clinical services. TRIAL REGISTRATION: ANZCTR Registration: ACTRN12617000411347 (Trial registered 22/03/2017; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true ).

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