Clinical pathways are an important strategy for implementing evidence into practice, but we know little about how to do this most effectively. The ADAPT Program is evaluating strategies for embedding a clinical pathway for identifying (using routine screening), assessing and managing anxiety and depression in cancer patients into routine care (ADAPT CP) , via an online portal. Based on the PARiHSimplementation framework and a barriers and facilitators analysis, The ADAPT CP is tailored for each site to accommodate their local resources, preferences and workflow.
We piloted ADAPT at one site for 5 months and conducted semi-structured interviews with staff post implementation. We used these data to refine our implementation strategies for a cluster randomised controlled trial involving 12 NSW cancer services. We have developed a detailed engagement process with each service to tailor the ADAPT CP and prepare the service for ADAPT implementation. Interviews are conducted with key staff post engagement (at the start of implementation), at 6 months into the 12-month implementation period, and at the end of the 12 months.
Thematic analysis of audio recorded interviews has revealed how important it is to address: 1) evidence (staff perceptions), 2) context (culture and external influences) and facilitation (intervention fit, familiarisation, engagement and burden). Engagement with staff at all levels from the beginning, accommodation of staff workflow, clarity of roles and referral networks, and flexible response to barriers arising over time are all critical.
Tailoring and flexibility of intervention content and process, and of implementation strategies, are essential to ensure successful implementation and sustainability of evidence-based interventions.