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

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dc.contributor.authorButow, Phyllis
dc.contributor.authorFaris, Mona M.
dc.contributor.authorShaw, Joanne
dc.contributor.authorKelly, Patrick
dc.contributor.authorHe, Sharon
dc.contributor.authorHarris, Marnie
dc.contributor.authorCuddy, Jessica
dc.contributor.authorMasya, Lindy
dc.contributor.authorGeerligs, Liesbeth
dc.contributor.authorKelly, Brian
dc.contributor.authorGirgis, Afaf
dc.contributor.authorRankin, Nicole
dc.contributor.authorBeale, Philip
dc.contributor.authorHack, Thomas F.
dc.contributor.authorKirsten, Laura
dc.contributor.authorDhillon, Haryana
dc.contributor.authorGrimison, Peter
dc.contributor.authorViney, Rosalie
dc.contributor.authorClayton, Josephine M.
dc.contributor.authorSchlub, Timothy
dc.contributor.authorShepherd, Heather L.
dc.date.accessioned2023-06-01T17:46:37Z
dc.date.available2023-06-01T17:46:37Z
dc.date.issued2023-05-22
dc.date.updated2023-06-01T03:27:50Z
dc.description.abstractAbstract 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 )en_US
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.citationImplementation Science. 2023 May 22;18(1):18
dc.identifier.doi10.1186/s13012-023-01269-0
dc.identifier.urihttp://hdl.handle.net/1993/37367
dc.language.isoengen_US
dc.language.rfc3066en
dc.publisherBioMed Central (BMC)en_US
dc.rightsopen accessen_US
dc.rights.holderThe Author(s)
dc.subjectanxietyen_US
dc.subjectdepressionen_US
dc.subjectcanceren_US
dc.subjectRCTen_US
dc.subjectpsychological managementen_US
dc.titleEffect 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 trialen_US
dc.typejournal articleen_US
local.author.affiliationRady Faculty of Health Sciences::Max Rady College of Medicine::Department of Internal Medicineen_US
oaire.citation.issue1en_US
oaire.citation.startPage18en_US
oaire.citation.titleImplementation Scienceen_US
oaire.citation.volume18en_US
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