Factors Influencing the Early Implementation of the Australian Clinical Pathway for the Screening, Assessment and Management of Anxiety and Depression in Adult Cancer Patients (ADAPT CP): Success Factors and Organisational Readiness for Change

Abstract

Background: Cancer is a deadly disease associated with significant distress; rates of psychological morbidity are significantly higher in people living with cancer than the general population. Most recent systematic reviews have demonstrated the efficacy of psychological interventions in reducing cancer-related distress, but such interventions are not routinely delivered. Understanding the barriers to implementation of evidence-based interventions is crucial to improving outcomes. Aims: This thesis sought to address critical gaps in our understanding of implementation in psycho-oncology, with a focus on early success factors and organisational readiness. This work was done within the implementation of the Australian Clinical Pathway for the Screening, Assessment and Management of Anxiety and Depression in Adult Cancer Patients (ADAPT CP). Method: A systematic review, a commentary paper, a pilot study and a main empirical study were carried out. These four published papers are accompanied by an introduction to the field, a methodology chapter and an integrated discussion. Results: The systematic review generated a model of staff, system and intervention factors in the implementation process. The commentary paper used an implementation science framework to develop measurable outcomes for ADAPT CP. The pilot study assessed two of these outcomes, acceptability and feasibility, using in-depth qualitative interviews with staff involved in the ADAPT CP pilot. Finally, the main empirical study used a mixed methods approach to explore factors impacting high and mid-range readiness across six services preparing to implement the ADAPT CP. Discussion: The findings of this thesis provide key insights to inform future implementation of evidence-based interventions. Collecting rigorous, theory informed data on stakeholder experiences are key to capturing meaningful answers to real-world implementation challenges, and increasing the likelihood of successful change.