Introduction
Digital health promises to facilitate delivery of clinical pathways (CPs) through use of automatic processes to minimise staff burden. The ADAPT Program uses a digital health solution, an online portal, to implement a CP for anxiety and depression (A/D) in cancer patients in 12 NSW Oncology services, tailored to accommodate local resources, preferences and workflow. This analysis explored the strategies staff reported using to successfully implement the CP.
Methods
Within a cluster randomised trial where sites implement ADAPT for 12 months, we gathered quantitative and qualitative data from all staff prior to ADAPT going live, and at 6 and 12 months, and interviewed psychosocial staff about iCanADAPT. After 8 engagement sessions with each site to tailor the CP and clarify staff responsibilities, staff attend training in using the portal. Online education in screening and assessing A/D and making psychosocial referrals is available to all staff. An online cognitive behavioural therapy program (iCanADAPT) was available to patients with mild to moderate A/D. Local data on ADAPT screening results and processes are made available to each site.
Results
To date (July 2019), 1305 screening events have been completed (653 first and 652 repeat screens). 5 of 6 sites who have completed the study elected to continue using ADAPT in routine care. Uptake of online training has been low (due to lack of dedicated time) as has patient referrals to iCanADAPT (due to unfamiliarity with and mistrust of online therapy). Staff needed tailored training on the portal. Little technical support has been required. Staff interviews revealed the importance of addressing: 1) evidence (staff perceptions), 2) context (culture and staff support) and facilitation (intervention fit, familiarisation, engagement and burden).
Discussion
Tailoring and flexibility of intervention content and process, and of implementation strategies, are essential to ensure successful implementation and long-term sustainability of digital interventions.