1
|
Geerligs L, Shepherd HL, Butow P, Shaw J, Masya L, Cuddy J, Rankin NM. What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). Support Care Cancer 2020; 29:3235-3244. [PMID: 33095356 DOI: 10.1007/s00520-020-05836-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/15/2020] [Indexed: 11/24/2022]
Abstract
AIMS Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). METHODS We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having 'high' versus 'mid-range' organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12-60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness. RESULTS Three services with high- (mean ORIC range, 52.25-56.88), and three with mid-range (range, 38.75-46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues. CONCLUSIONS Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.
Collapse
Affiliation(s)
- L Geerligs
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
| | - H L Shepherd
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), The University of Sydney, Sydney, NSW, Australia
| | - P Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), The University of Sydney, Sydney, NSW, Australia
| | - J Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), The University of Sydney, Sydney, NSW, Australia
| | - L Masya
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
| | - J Cuddy
- Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
| | | | - N M Rankin
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,School of Public Health, Faculty of Medicine and Health, The University of Sydney, c/o Charles Perkins Centre Level 2 (D17), Sydney, NSW, 2006, Australia.
| |
Collapse
|
2
|
Murphy MJ, Newby JM, Butow P, Loughnan SA, Joubert AE, Kirsten L, Allison K, Shaw J, Shepherd HL, Smith J, Andrews G. Randomised controlled trial of internet-delivered cognitive behaviour therapy for clinical depression and/or anxiety in cancer survivors (iCanADAPT Early). Psychooncology 2019; 29:76-85. [PMID: 31659822 DOI: 10.1002/pon.5267] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 09/26/2019] [Accepted: 10/13/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate internet-delivered cognitive behavioural therapy (iCBT) on clinical depression and/or anxiety, distress, fear of cancer recurrence, and quality of life in cancer survivors. METHODS Random assignation of 114 participants to iCBT or treatment-as-usual (TAU). The clinician-supervised iCBT program (iCanADAPT Early) consisted of eight lessons over 16 weeks. Self-report questionnaires occurred at baseline, midpoint, and posttreatment for both groups with 3-month follow-up for iCBT participants. A mixed modelling approach to compare groups occurred. RESULTS iCBT was superior to TAU on all outcome measures at posttreatment. Compared with TAU, the iCBT group showed a significant decrease over time in anxiety and depression symptoms (primary outcome, Hospital Anxiety and Depression Scale, Hedges g = 1.51). Additionally the iCBT group had significantly lower general distress (Kessler-10, g = 1.56), fear of cancer recurrence (Fear of Cancer Recurrence Inventory, g = 0.39), and significantly higher quality of life (Functional Assessment of Cancer Therapy-General, g = 0.74) at posttreatment compared with the TAU group. High adherence and satisfaction were found for iCBT with low clinician time. CONCLUSION Clinician-supervised iCBT has significant benefits for cancer survivors with clinical depression and anxiety disorders.
Collapse
Affiliation(s)
- M J Murphy
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - J M Newby
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia.,School of Psychology, Faculty of Science, UNSW, NSW, Australia
| | - P Butow
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - S A Loughnan
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - A E Joubert
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - L Kirsten
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia.,Nepean Cancer Care Centre, NSW, Australia
| | - K Allison
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - J Shaw
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - H L Shepherd
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - J Smith
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - G Andrews
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| |
Collapse
|
3
|
Young JM, Masya LM, Solomon MJ, Shepherd HL. Identifying indicators of colorectal cancer care coordination: a Delphi study. Colorectal Dis 2014; 16:17-25. [PMID: 24034416 DOI: 10.1111/codi.12399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/16/2013] [Indexed: 02/03/2023]
Abstract
AIM Care coordination is an important aspect of the quality of cancer care but is difficult to evaluate due to the lack of valid and reliable measures. This study was conducted to identify a set of objective measures of colorectal cancer care coordination that could be included in a medical record audit tool. METHOD A two-stage Delphi study was conducted to gain consensus among a national panel of experts about the validity of 41 potential indicators of colorectal cancer care coordination that had been identified during a literature review. The expert panel comprised 20 members from the National Health and Medical Research Colorectal Cancer Guidelines Working Party plus representatives from cancer nursing/coordination, general practice and cancer consumers. RESULTS Consensus was reached on the validity of 15 of 41 potential indicators, including those that focused on practical aspects of communication (legibility, clarity, content and timeliness of hospital discharge letters, documentation of outcomes of multidisciplinary team meetings) and appropriateness (documentation of preoperative consultation with a stoma therapist, discussions and referrals for adjuvant therapy for appropriate patients, and treatment by an experienced colorectal surgeon). There was lack of consensus on the validity of indicators relating to access to and efficiency of services. CONCLUSION The study has identified a core set of measures considered to be valid indicators of colorectal cancer care coordination. A medical record audit based on these measures could be used to monitor adequacy of cancer care coordination and will complement subjective measures based on self-reported experiences of patients and carers.
Collapse
Affiliation(s)
- J M Young
- Cancer Epidemiology and Cancer Services Research Group, Sydney School of Public Health, University of Sydney and Cancer Institute NSW, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
4
|
Laidsaar-Powell RC, Butow PN, Bu S, Charles C, Gafni A, Lam WWT, Jansen J, McCaffery KJ, Shepherd HL, Tattersall MHN, Juraskova I. Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. Patient Educ Couns 2013; 91:3-13. [PMID: 23332193 DOI: 10.1016/j.pec.2012.11.007] [Citation(s) in RCA: 255] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 10/31/2012] [Accepted: 11/04/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To systematically review quantitative and qualitative studies exploring physician-adult patient-adult companion (triadic) communication and/or decision-making within all medical encounters. METHODS Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria. RESULTS Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely. CONCLUSION Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed. PRACTICE IMPLICATIONS Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.
Collapse
Affiliation(s)
- R C Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
Most cancer patients in westernised countries now want all information about their situation, good or bad, and many wish to be involved in decision-making. The attitudes to and use of shared decision-making (SDM) by cancer doctors is not well known. Australian cancer clinicians treating breast, colorectal, gynaecological, haematological, or urological cancer were surveyed to identify their usual approach to decision-making and their comfort with different decision-making styles when discussing treatment with patients. A response rate of 59% resulted in 624 complete surveys, which explored usual practice in discussing participation in decision-making, providing information, and perception of the role patients want to play. Univariate and multivariate analyses were performed to identify predictors of use of SDM. Most cancer doctors (62.4%) reported using SDM and being most comfortable with this approach. Differences were apparent between reported high comfort with SDM and less frequent usual practice. Multivariate analysis showed that specialisation in breast or urological cancers compared to other cancers (AOR 3.02), high caseload of new patients per month (AOR 2.81) and female gender (AOR 1.87) were each independently associated with increased likelihood of use of SDM. Barriers exist to the application of SDM by doctors according to clinical situation and clinician characteristics.
Collapse
Affiliation(s)
- H L Shepherd
- Medical Psychology Research Unit, Faculty of Medicine, Blackburn Building, University of Sydney, NSW 2006, Australia.
| | | | | |
Collapse
|
6
|
Shepherd HL, Tchobanoglous G, Grismer ME. Time-dependent retardation model for chemical oxygen demand removal in a subsurface-flow constructed wetland for winery wastewater treatment. Water Environ Res 2001; 73:597-606. [PMID: 11765996 DOI: 10.2175/106143001x143321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The relative success of chemical oxygen demand (COD) removal models to describe measured rates of COD removal in a pilot-scale constructed wetland designed for treatment of high-strength winery wastewater are evaluated using retention times determined from tracer studies. Not surprisingly, two-parameter residual and retardation models better fit the measured removal data than single-parameter, first-order decay models for wastewater at average COD loadings up to nearly 5000 mg/L. The residual and retardation models yielded nearly equivalent fits to the measured data. However, the retardation model had more consistent parameters for COD removal data across different depth levels in the constructed wetland and at different loadings, and a slightly smaller sum of least-squared errors. The retardation model seems to be appropriate for constructed wetland design because it allows a steady decrease in COD with increased treatment time rather than a constant residual COD (C*) value. From the least-squares optimization procedure used to estimate model parameters (a volumetric rate constant, Kv, range of 3 to 12 d(-1)), nonrealistic, or physically meaningless, large C* values (C* range of 23 to 450 mg COD/L) that were dependent on COD loading were obtained, potentially underestimating the constructed wetland system's actual winery wastewater treatment potential. The optimal parameters for the retardation model applied to the pilot-scale constructed wetland ranged from 9 to 12 d(-1) for the initial degradation rate constant, Ko, and 2 to 5 d(-1) for the time-based retardation coefficient, b. These values should be verified for full-scale field systems based on field measurements currently underway.
Collapse
Affiliation(s)
- H L Shepherd
- Komex-H2O Science, Huntington Beach, California, USA
| | | | | |
Collapse
|
7
|
Shepherd HL, Potter MF, Corner BD, Watson-Williams EJ. The quadruplets. Bristol Med Chir J (1883) 1949; 66:14-9. [PMID: 18125207 PMCID: PMC5068980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H. L. Shepherd
- Obstetrician, Bristol Royal Hospital Visiting Obstetrician, Southmead Hospital
| | - Mabel F. Potter
- Obstetrician, Bristol Royal Hospital Visiting Obstetrician, Southmead Hospital
| | - Beryl D. Corner
- Physician, Bristol Royal Hospital for Sick Children; Pædiatrician, Southmead Hospital
| | | |
Collapse
|
8
|
Smythe HJD, Shepherd HL. Midwifery in Bristol. Bristol Med Chir J (1883) 1940; 57:117-120. [PMID: 28897690 PMCID: PMC5058238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
| | - H. L. Shepherd
- Consultant Obstetrician, Obstetrical Unit, Southmead Hospital
| |
Collapse
|