Utilization and evaluation of a clinical pathway for managing anxiety and depression in cancer patients

The Clinical Pathway for the Screening, Assessment and Management of Anxiety and Depression in Adult Cancer Patients (ADAPT) will be implemented into routine care at Ramsay Health Care Lake Macquarie Private Hospital. Implementation strategies to support adherence to the Clinical Pathway into routine care will be provided. The ADAPT Portal is an online, integrated management system that allows cancer service staff to operationalise the Clinical Pathway and has the following essential features and functions: i. Patient Registration, Management and Referral Cancer patient details are entered into the Portal by cancer service staff. The Portal generates a screening date for each patient and alerts staff when patients are due to screen. The Portal generates a screening alert for patients every 3-months, and also at key points in their treatment. If a patient screens with high levels of depression and/or anxiety, the Portal alerts staff that the patient requires triage. After triage, the Portal alerts clinical staff as to the relevant step of the Clinical Pathway for each individual patient, and the appropriate referrals and support to offer. The Portal provides standardised templates for referral and feedback to/from Ramsay Psychology, Charlestown services when required. Data extracted from the ADAPT Portal will report on adherence, capturing for each patient, whether they received the ADAPT CP components (screening, triage conversation, referral, referral uptake check, progress review, discharge summary, and rescreening) appropriate for their level of anxiety and depression. ii. Patient screening and education materials When cancer service staff register a patient's details in the Portal, the system generates a log-in for the patient. Patients may then log-in to their own individual pages within the Portal where they are systematically prompted to complete validated screening and assessment questionnaires online. Using their log-in, patients may also access written patient information that explains the importance of screening for anxiety and depression, and the process involved for patients in the use of the Clinical Pathway, specifically developed for ADAPT. These patient information materials will also link to existing patient/caregiver resources about cancer-related anxiety and depression. Patients may access these resources at their own discretion with no minimum engagement required. The ADAPT Portal tracks patient access to resources. iii. Online therapy treatment programs Two programs delivering online psychological therapy have been developed by the ADAPT Program for patients with early stage or advanced stage cancer identified as having symptoms of anxiety and/ or depression. The therapy includes behavioural activation, cognitive restructuring and problem solving, attentional training and mindfulness strategies, completed in 6-8 sessions over 10-12 weeks. These self-directed online modules including written information, short videos and activities are available in the ADAPT Portal for patient self-referral or clinician referral. Each session will take patients approximately 45-60 minutes to complete. Data extracted from the ADAPT Portal will allow for monitoring of patients access to and completion of the online therapy modules. iv. Online Health Professional Education Modules Five online education modules have been developed using evidence-based learning principles and spaced education to promote interactive learning. This education targets screening, assessing severity, making a referral - particularly when patients are reluctant - and empathic communication. Modules take approximately 30-45 minutes to complete and incorporate a mix of written information, short videos and interactive activities. The online modules will be delivered to staff over a five week period in facilitated sessions. Staff will be prompted to undertake annual refreshers by the portal. Modules will be available on eviQ, the most widely used Oncology education site in Australia, with links in the ADAPT Portal. As online health professional educations modules will be undertaken during facilitated sessions, completion of these modules will be monitored. Ramsay Health Care Lake Macquarie Private Hospital cancer service staff will also receive the following implementation strategies: During the engagement period (6 months prior to ADAPT Portal go live) ADAPT Program staff will work with the site to identify local champion(s) to provide initial training and support. ADAPT Portal and Clinical Pathway Champions will provide the Portal and Clinical Pathway training to hospital staff and be the point of contact for Ramsay Health Care Lake Macquarie Private Hospital cancer service staff who have questions when implementing the ADAPT Portal and Clinical Pathway. These staff will be trained on the ADAPT Portal and Clinical Pathway in a half-day group workshop, with ongoing support provided via telephone/email. Roadshow and poster campaigns to inform cancer service staff about the Clinical Pathway and the Portal. The poster campaign will be freely accessible to all staff and viewed throughout the hospital at staff discretion. The roadshow presentation will be held at the hospital at a suitable time for majority of staff and made available online for those staff unable to attend. All staff will be trained to use the Portal, in face-to-face training, by engaging with User Guides and by seeking the support of the Local Champion. This half-day training workshop will be provided by the Champion with assistance from the ADAPT Program staff and will take place in the month leading up to the Portal and Clinical Pathway go live date. Reports will be provided to site Leads and Champions regarding use of the Portal and the Clinical Pathway issues and concerns.