Introduction
depression, adult cancer, anxiety/depression, anxiety
SECONDARY
Clinical pathways (CPs) are standardised, evidence-based multidisciplinary management plans, which identify an appropriate sequence of clinical interventions, timeframes, milestones and expected outcomes for one or more patient groups [However, while CPs have been shown to improve patient outcomes, this is not always the case [Due to these negative outcomes, increasing research effort has explored strategies to promote uptake and adherent use of health service interventions [Our group developed a CP for screening, assessment and management of anxiety and depression in adult cancer patients (the ADAPT CP) to guide best practice in Australia [Our team has reported extensively on implementation preparation, processes and outcomes of the ADAPT trial [In this cluster trial, our primary objective was to determine whether “dose” of implementation strategy (Core versus Enhanced) effects staff adherence to the ADAPT CP. Our secondary objective was to examine the effect of step allocation (overall, and by implementation support arm) on total and component adherence scores.Our primary hypothesis was that the proportion of eligible patients screened, for whom sites achieve acceptable adherence to the ADAPT CP (defined as yes: having completed ≥ 70% of the recommended ADAPT CP components versus no.: < 70%) would be greater in the Enhanced implementation strategy arm than in the Core implementation strategy arm.Secondary hypotheses included that:Adherence scores for each component of the ADAPT CP would be greater in the Enhanced implementation strategy arm than in the Core implementation strategy arm.As more actions are required of staff for higher (more severe) steps of anxiety/depression, adherence would be lower for higher than for lower steps of anxiety and depression.There would be a significant interaction between step and implementation strategy arm, with better adherence to higher steps of anxiety and depression in the Enhanced implementation strategy arm than that in the Core implementation support arm.