Live Virtual Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Implementing a clinical pathway for cancer-related anxiety and depression in 12 NSW Oncology services: Lessons learned  (#132)

Phyllis Butow 1 , Heather Shepherd 1 , Joanne Shaw 1
  1. Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia


Clinical pathways (CPs) can improve health outcomes, but may be hard to introduce into routine clinical care. We developed a CP for anxiety and depression in cancer patients (the ADAPT CP) and implemented it in 12 Oncology services in Australia. We engaged with services to tailor the CP for local conditions and determine staff responsibilities and workflows. This presentation will outline lessons learned during that process, and from staff feedback across the implementation period.


Twelve oncology services were recruited (10 publicly funded, 1 privately funded and 1 a mixed public and private service). Purposively selected staff (n=88) were interviewed just prior to implementation of the CP and 6 months later (half-way through the implementation period). Monthly meetings with lead multi-disciplinary teams (at half the sites) and adhoc contacts were recorded. Data were thematically analysed.


Engaging all stakeholders, identifying multi-disciplinary champions, giving staff ownership of the CP and tailoring the CP to local workflows were critical in ensuring success. Participant belief in the evidence-base and credibility of ADAPT was strong, but some staff perceived no need for ADAPT, as their current systems were adequate, limiting uptake. Contextual challenges (changing EMR systems, restructuring, staff turnover) occurred in some sites. Perceived burden (“this is not my role, we don’t have time or high-level support”) was a key barrier. Yet services displayed enormous commitment and creativity in creating systems to overcome barriers. They created, reviewed and tweaked processes to optimise success.


This study demonstrates the interactive nature of health service change, with staff actively engaging with, forming views on, and problem-solving solutions for a CP for managing anxiety and depression in cancer patients. Obtaining staff feedback is critical to ensure health service change is sustainable, meaningful and achieves its promise of improving patient outcomes.