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What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP)

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Aims

Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP).

Methods

We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having ‘high’ versus ‘mid-range’ organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12–60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness.

Results

Three services with high- (mean ORIC range, 52.25–56.88), and three with mid-range (range, 38.75–46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues.

Conclusions

Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.

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Data availability

The data have been fully analysed for this manuscript and therefore are not publicly available, although the researchers are happy to consider reasonable requests via a written request to the corresponding author.

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Acknowledgements

The authors acknowledge and thank the cancer service, the staff and the patients for their participation in the feasibility study. The ADAPT Portal and ADAPT CP were developed as part of the Anxiety and Depression Pathway (ADAPT) Program, led by the Psycho-oncology Co-operative Research Group (PoCoG). Members of the ADAPT Program Group have contributed to ADAPT activities and resources. The authors acknowledge the ADAPT Program group members for their contribution to the design and delivery of the ADAPT Program. The authors would like to acknowledge the commitment and contribution to this study of Dr. Melanie Price (1965–2018). Dr. Price was a respected member of the psycho-oncology and palliative care community in Australia for over 22 years. She was a tireless advocate for people affected by cancer, their families and psycho-oncology as a discipline.

ADAPT Program group members: Prof Gavin Andrews, Kate Baychek, A/Prof Philip Beale, Karen Allison, A/Prof Josephine Clayton, Dr. Joseph Coll, Jessica Cuddy, Prof Afaf Girgis, Dr. Peter Grimison, Prof Tom Hack, Prof Brian Kelly, Dr. Laura Kirsten, Dr. Toni Lindsay, A/Prof Melanie Lovell, Dr. Tim Luckett, Dr. Michael Murphy, Dr. Jill Newby, Dr. Frances Orr, Dr. Alison Pearce, Don Piro, Prof Tim Shaw, John Stubbs Prof Rosalie Viney, Fiona White, Jackie Yim.

Funding

The ADAPT Program is funded by a Translational Program Grant (14/TPG/1-02) from the Cancer Institute NSW. Liesbeth Geerligs is funded by a scholarship from the Australian Post-Graduate Awards Scheme (Australian Government), and additional top-up funding from Sydney Catalyst Translational Cancer Research Centre (based at the University of Sydney) and the ADAPT Program. The funding bodies had no role in study design, data collection, analysis or writing of the manuscript.

Author information

Authors and Affiliations

  1. Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia

    L. Geerligs, H. L. Shepherd, P. Butow, J. Shaw, L. Masya & J. Cuddy

  2. Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), The University of Sydney, Sydney, NSW, Australia

    H. L. Shepherd, P. Butow & J. Shaw

  3. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    N. M. Rankin

  4. School of Public Health, Faculty of Medicine and Health, The University of Sydney, c/o Charles Perkins Centre Level 2 (D17), Sydney, NSW, 2006, Australia

    N. M. Rankin

Authors
  1. L. Geerligs
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  2. H. L. Shepherd
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  3. P. Butow
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  4. J. Shaw
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  5. L. Masya
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  6. J. Cuddy
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  7. N. M. Rankin
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Consortia

The ADAPT Program Group

  • Gavin Andrews
  • , Kate Baychek
  • , Philip Beale
  • , Karen Allison
  • , Josephine Clayton
  • , Joseph Coll
  • , Jessica Cuddy
  • , Afaf Girgis
  • , Peter Grimison
  • , Tom Hack
  • , Brian Kelly
  • , Laura Kirsten
  • , Toni Lindsay
  • , Melanie Lovell
  • , Tim Luckett
  • , Michael Murphy
  • , Jill Newby
  • , Frances Orr
  • , Alison Pearce
  • , Don Piro
  • , Tim Shaw
  • , John Stubbs
  • , Rosalie Viney
  • , Fiona White
  •  & Jackie Yim

Contributions

LG, PB, HS and NR were involved in conceptualising the manuscript. JS and LM provided clinical and academic expertise throughout the ADAPT pre-implementation process. LM and JC oversaw quantitative data collection. LG carried out all qualitative interviews. LG, HS, PB and NR contributed to the development of the thematic framework. LG wrote the first draft of the manuscript. NR, HS and PB made significant contributions to preliminary drafts. All authors contributed to making revisions of the later drafts, and all authors read and approved the final manuscript.

Corresponding author

Correspondence to N. M. Rankin.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Code availability

Not applicable.

Ethics approval

The study was approved by the Sydney Local Health District Human Research Ethics Committee, Protocol X16-0378 HREC/16/RPAH/522.

Consent to participate

All participants provided informed consent to take part in the study.

Consent for publication

All participants were informed about the intention to publish the findings and gave informed consent.

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Appendix

Appendix

Table 5 Additional quotes for each theme
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Geerligs, L., Shepherd, H.L., Butow, P. et al. What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). Support Care Cancer 29, 3235–3244 (2021). https://doi.org/10.1007/s00520-020-05836-9

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  • DOI: https://doi.org/10.1007/s00520-020-05836-9

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