Discussion
anxiety/depression CP, depression, cancer, anxiety
CANCER, POSITIVE
This study examined staff perceptions of their service’s level of readiness to implement the ADAPT CP, and identified factors associated with organisational readiness. As measured by the ORIC scale, readiness to implement change was relatively high, which may be attributed to the extensive engagement with services prior to implementation to recruit champions, tailoring of the clinical pathway (e.g., identify existing referral pathways, integrate the clinical pathway into workflows), staff training, and awareness raising activities. Alternatively, there may have been sample bias, with services readier to implement the ADAPT CP more likely to agree to participate in the study. While perceived readiness was relatively high, there remains an opportunity to further increase readiness and identify the generalisable learnings about what influences readiness for use in other contexts.Holt et al. [We hypothesised that factors relating to psychosocial staff or the psychosocial care of patients would be associated with organisational readiness. Our hypothesis was only partly supported because, aside from staff role (which included staff in psychosocial roles) emerging as a significant predictor of organisational readiness, history of psychosocial screening, and clinical load of psychosocial staff were not significant predictors.Staff in administrative, technical support and non-clinical roles had significantly higher organisational readiness scores compared to psychosocial staff. As the focus of the ADAPT CP was on the identification and management of distress and anxiety and depression in patients, this finding was surprising given the experience of psychosocial staff in providing psychological care. However, psychosocial staff may have felt more responsible for, and burdened by, the ADAPT CP than other staff, and thus less ready for this change. While the aim was for the ADAPT CP to be a multidisciplinary, whole-of-service initiative, with staff across various roles playing an important part in enacting the ADAPT CP within their service, across most services, more roles were allocated to psychosocial staff by lead team members [Positive attitudes toward the acceptability and appropriateness of the ADAPT CP were also associated with higher levels of perceived organisational readiness. Indeed, Weiner [Organisational readiness scores were significantly higher for services which implemented the ADAPT CP in four treatment modalities versus one. This suggests that staff who were confident in their service’s ability to implement the ADAPT CP were also confident to apply it in more than one treatment modality. As noted in a previous qualitative study which examined the rationale for what and why decisions were made to tailor the ADAPT CP across the 12 cancer services [There are some potential limitations of the present study. The first is related to the survey response rates. In this study, few staff completed the surveys relative to the number of surveys sent. We cannot rule out the possibility that those who completed the survey may have been more engaged with the ADAPT program and held more positive views of the ADAPT CP, potentially introducing some level of bias. Thus, the high perceived benefit scores reported may not be representative of all staffs’ views. Additionally, as part of the larger program of work, the ORIC scale was also administered at the midpoint and endpoint of the implementation period (Additional file Second, we were able to examine only 2 out of the 4 types of factors proposed by Holt and colleagues as being influential to organisational readiness (staff and service-level factors) [This study did, however, have several strengths, including the size and complexity of the trial, its focus on organisational readiness both from a quantitative perspective here, and a qualitative perspective in our earlier paper [In conclusion, this study identified a high level of readiness for implementing an anxiety/depression CP in routine cancer care, in 12 cancer services. Factors associated with organisational readiness for change suggested the importance of adequately resourcing and supporting staff to implement change, effectively communicating the value of the change, and taking a whole-of-service approach to change. However, a potential sample bias may exist, therefore caution is needed in interpretating the results and assuming generalisability of the results. Future studies of complex multi-component interventions trials that test implementation strategies are needed to identify additional factors that may be associated with readiness and engagement with change processes.