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
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 (t...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-023-01269-0 |
| _version_ | 1827939770356989952 |
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| author | Phyllis Butow Mona M. Faris Joanne Shaw Patrick Kelly Sharon He Marnie Harris Jessica Cuddy Lindy Masya Liesbeth Geerligs Brian Kelly Afaf Girgis Nicole Rankin Philip Beale Thomas F. Hack Laura Kirsten Haryana Dhillon Peter Grimison Rosalie Viney Josephine M. Clayton Timothy Schlub The ADAPT Program Group Heather L. Shepherd |
| author_facet | Phyllis Butow Mona M. Faris Joanne Shaw Patrick Kelly Sharon He Marnie Harris Jessica Cuddy Lindy Masya Liesbeth Geerligs Brian Kelly Afaf Girgis Nicole Rankin Philip Beale Thomas F. Hack Laura Kirsten Haryana Dhillon Peter Grimison Rosalie Viney Josephine M. Clayton Timothy Schlub The ADAPT Program Group Heather L. Shepherd |
| author_sort | Phyllis Butow |
| collection | DOAJ |
| 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 ) |
| first_indexed | 2024-03-13T08:59:22Z |
| format | Article |
| id | doaj.art-69e817e8ef6c45648d7b259a725f0a8e |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-03-13T08:59:22Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-69e817e8ef6c45648d7b259a725f0a8e2023-05-28T11:23:38ZengBMCImplementation Science1748-59082023-05-0118111810.1186/s13012-023-01269-0Effect 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 trialPhyllis Butow0Mona M. Faris1Joanne Shaw2Patrick Kelly3Sharon He4Marnie Harris5Jessica Cuddy6Lindy Masya7Liesbeth Geerligs8Brian Kelly9Afaf Girgis10Nicole Rankin11Philip Beale12Thomas F. Hack13Laura Kirsten14Haryana Dhillon15Peter Grimison16Rosalie Viney17Josephine M. Clayton18Timothy Schlub19The ADAPT Program GroupHeather L. Shepherd20School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Public Health, Faculty of Medicine and Health, The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneySouth West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South WalesFaculty of Medicine and Health, The University of SydneyDepartment of Medical Oncology, Concord HospitalCollege of Nursing, Rady Faculty of Health Sciences, University of ManitobaNepean Hospital, Nepean Cancer Care CentreSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneyChris O’Brien LifehouseCamperdownCentre for Health Economics Research and Evaluation, University of TechnologyHammondCare, The Palliative Centre, Greenwich HospitalSchool of Public Health, Faculty of Medicine and Health, The University of SydneySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of SydneyAbstract 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 )https://doi.org/10.1186/s13012-023-01269-0Implementation strategiesCluster randomised controlled trialAnxiety and depression management |
| spellingShingle | Phyllis Butow Mona M. Faris Joanne Shaw Patrick Kelly Sharon He Marnie Harris Jessica Cuddy Lindy Masya Liesbeth Geerligs Brian Kelly Afaf Girgis Nicole Rankin Philip Beale Thomas F. Hack Laura Kirsten Haryana Dhillon Peter Grimison Rosalie Viney Josephine M. Clayton Timothy Schlub The ADAPT Program Group Heather L. Shepherd 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 Implementation Science Implementation strategies Cluster randomised controlled trial Anxiety and depression management |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Implementation strategies Cluster randomised controlled trial Anxiety and depression management |
| url | https://doi.org/10.1186/s13012-023-01269-0 |
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