Aims: Cancer patients report significantly higher rates of psycho-social distress than the general population; implementation of routine screening and management is a key priority to address this. Most research to date has focused on routine screening only. This study identified the barriers and facilitators encountered during the pre-implementation phase of a clinical pathway for the screening and management of anxiety and depression (the ADAPT CP) in cancer services in NSW hospitals.
Methods: We conducted semi-structured interviews with hospital staff in different roles from six hospitals (three regional, three metropolitan) following 3 months of site engagement and planning meetings and prior to the roll-out of the ADAPT CP. Interviews focused on experiences of pre-implementation, and anticipated barriers and facilitators to successful implementation. Thematic analysis was used to analyse these data.
Results: Fifty-one multi-disciplinary staff participated, including psychologists, social workers, nurses, oncologists, administrative and managerial staff. Key themes identified related to service culture and team cohesion; beliefs regarding the significance of mental health in cancer care; tensions within multidisciplinary teams regarding role responsibilities, time and workload burden; and issues of integration/tailoring of the ADAPT CP to suit the needs of service, staff and patients. Context-specific barriers were also identified that related to service location, size and number of tumour streams.
Conclusions: Barriers and facilitators were similar to those identified during the barrier analysis carried out as part of the clinical pathway development, and planned to be addressed during implementation by the implementation strategies prepared to support roll-out of the ADAPT CP within each service. Ongoing consultation with staff stakeholders during engagement allowed for fast identification of the main barriers at each service, responsive tailoring of the ADAPT CP to meet the context and culture needs and use of targeted implementation strategies to improve implementation success.