Evidence map›Paper›PMID 37217928›Full record

Trial reportImplementation science : IS2023

Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial.

Phyllis Butow, Mona M Faris, Joanne Shaw, Patrick Kelly, Sharon He, Marnie Harris, Jessica Cuddy, Lindy Masya, Liesbeth Geerligs, Brian Kelly and 12 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Phyllis ButowSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia. phyllis.butow@sydney.edu.au.ORCID 0000-0003-3562-6954
Mona M FarisSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Joanne ShawSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Patrick KellySchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Sharon HeSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Marnie HarrisSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Jessica CuddySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Lindy MasyaSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Liesbeth GeerligsSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Brian KellySchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Afaf GirgisSouth West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Kensington, Australia.
Nicole RankinFaculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Philip BealeDepartment of Medical Oncology, Concord Hospital, NSW, Concord, Australia.
Thomas F HackCollege of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Laura KirstenNepean Hospital, Nepean Cancer Care Centre, Kingswood, NSW, Australia.
Haryana DhillonSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.
Peter GrimisonChris O'Brien LifehouseCamperdown, Sydney, NSW, Australia.
Rosalie VineyCentre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.
Josephine M ClaytonHammondCare, The Palliative Centre, Greenwich Hospital, Greenwich, NSW, Australia.
Timothy SchlubSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
ADAPT Program Group
Heather L ShepherdSchool of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, 31 Ellalong Rd North Turramurra 2074, Sydney, NSW, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOptimal strategies to facilitate implementation of evidence-based clinical pathways are unclear. We evaluated two implementation strategies (Core versus Enhanced) to facilitate implementation of a clinical pathway for the management of anxiety and depression in cancer patients (the ADAPT CP).

methodsTwelve cancer services in NSW Australia were cluster randomised, stratified by service size, to the Core versus Enhanced implementation strategy. Each strategy was in place for 12 months, facilitating uptake of the ADAPT CP (the intervention being implemented). The Core strategy included a lead team with champions, staff training and awareness campaigns prior to implementation, plus access to feedback reports and telephone or online support during implementation. The Enhanced strategy included all Core supports plus monthly lead team meetings, and proactive, ongoing advice on managing barriers, staff training and awareness campaigns throughout implementation. All patients at participating sites were offered the ADAPT CP as part of routine care, and if agreeable, completed screening measures. They were allocated a severity step for anxiety/depression from one (minimal) to five (severe) and recommended management appropriate to their severity step. Multi-level mixed-effect regression analyses examined the effect of Core versus Enhanced implementation strategy on adherence to the ADAPT CP (binary primary outcome: adherent ≥ 70% of key ADAPT CP components achieved versus non-adherent < 70%), with continuous adherence as a secondary outcome. Interaction between study arm and anxiety/depression severity step was also explored.

resultsOf 1280 registered patients, 696 (54%) completed at least one screening. As patients were encouraged to re-screen, there were in total 1323 screening events (883 in Core and 440 in Enhanced services). The main effect of implementation strategy on adherence was non-significant in both binary and continuous analyses. Anxiety/depression step was significant, with adherence being higher for step 1 than for other steps (p = 0.001, OR = 0.05, 95% CI 0.02-0.10). The interaction between study arm and anxiety/depression step was significant (p = 0.02) in the continuous adherence analysis only: adherence was significantly higher (by 7.6% points (95% CI 0.08-15.1%) for step 3 in the Enhanced arm (p = .048) and trending to significance for step 4. DISCUSSION: These results support ongoing implementation effort for the first year of implementation to ensure successful uptake of new clinical pathways in over-burdened clinical services.

trial registrationANZCTR Registration: ACTRN12617000411347 (Trial registered 22/03/2017; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true ).

Indexed as

Critical PathwaysNeoplasmsAnxietyAnxiety DisordersDepressionHumansAnxiety and depression managementCluster randomised controlled trialImplementation strategies

Identifiers

PMID37217928
PMCPMC10204284

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.