Background
Methods
Study design and setting
Study procedures
Study arms
ADAPT CP process
Staff participants
Data collection
Questionnaires
Interviews
Analysis
Results
Site ID | Allocated Study Arm | Site Location | Funding Type | Number of patients seen per 3-month period | Number of departments included | Treatment modality departments included | Tumour Streams included | Number of streams included | FTE Psycho-social staff | Screening History in past 12 months |
---|---|---|---|---|---|---|---|---|---|---|
1 | Core | Major city | Public | ≥100 | 3 | Med Oncology Rad Oncology Haematology | All | ≥3 | 0.8 | Yes |
2 | Enhanced | Inner regional | Public | < 100 | 4 | Med Oncology Rad Oncology Haematology Surgical | All | ≥3 | 0.6 | No |
3 | Core | Inner regional | Public | < 100 | 1 | Med Oncology | All | ≥3 | 0.6 | No |
4 | Enhanced | Major city | Public | ≥100 | 2 | Med Oncology Surgical | Gastro-intestinal | 1 | 2.4 | No |
5 | Enhanced | Inner regional | Public | < 100 | 3 | Med Oncology Rad Oncology Haematology | All | ≥3 | 1 | Yes |
6 | Enhanced | Major city | Public | ≥100 | 2 | Med oncology Haematology | All | ≥3 | 7.9 | No |
7 | Enhanced | Major city | Public | ≥100 | 1 | Surgical | Upper GI | 1 | 2.4 | Yes |
8 | Enhanced | Major city | Public | < 100 | 3 | Med Oncology Rad Oncology Haematology | All | ≥3 | 5 | Yes |
9 | Enhanced | Major city | Public | ≥100 | 1 | Haematology | Lymphoma, acute leukemia, multiple myeloma | ≥3 | 2.4 | No |
10 | Enhanced | Major city | Public | ≥100 | 3 | Med Oncology Rad Oncology Surgical | Head & Neck | 1 | 4 | No |
11 | Core | Major city | Public and Private | ≥100 | 1 | Med Oncology | Sarcoma, Gynae | 2 | 6.9 | Yes |
12 | Core | Major city | Private | ≥100 | 1 | Med Oncology | All | ≥3 | 0.9 | No |
Quantitative data
T0 (n = 106) | T1 (n = 58) | T2 (n = 57) | ||||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Age Range (in years) | ||||||
18–25 | 3 | 2.8 | 1 | 1.7 | 1 | 1.8 |
26–50 | 73 | 68.9 | 40 | 69.0 | 44 | 77.2 |
51–75 | 30 | 28.3 | 17 | 29.3 | 12 | 21.1 |
Gender | ||||||
Female | 91 | 85.8 | 50 | 86.2 | 51 | 89.5 |
Male | 15 | 14.2 | 8 | 13.8 | 6 | 10.5 |
aRole | ||||||
Nursing staff | 47 | 44.3 | 21 | 36.2 | 22 | 38.6 |
Medical staff | 17 | 16.0 | 10 | 17.2 | 6 | 10.5 |
Allied health & clinical trials staff | 9 | 8.5 | 1 | 1.7 | 2 | 3.5 |
Administrative, technical support and non-clinical managers | 11 | 10.4 | 7 | 12.1 | 5 | 8.8 |
Psycho-social staff | 21 | 19.8 | 18 | 31.0 | 15 | 26.3 |
Unspecified role | 1 | 0.9 | 1 | 1.7 | 1 | 1.8 |
Missing | 0 | 0.0 | 0 | 0.0 | 6 | 10.5 |
Employment Status | ||||||
Full-Time | 70 | 66.0 | 36 | 62.1 | 39 | 68.4 |
Part-Time | 36 | 34.0 | 22 | 37.9 | 18 | 31.6 |
Years of employment in current role | ||||||
< 1 year | 12 | 11.3 | 2 | 3.4 | 2 | 3.5 |
1–5 years | 52 | 49.1 | 33 | 56.9 | 34 | 59.6 |
6–20 years | 35 | 33.0 | 21 | 36.2 | 20 | 35.1 |
21> | 7 | 6.6 | 2 | 3.4 | 1 | 1.8 |
Language spoken at home | ||||||
English | 85 | 80.2 | 48 | 82.8 | 45 | 78.9 |
bOther | 21 | 19.4 | 8 | 13.7 | 12 | 21.3 |
Missing | 0 | 0.0 | 2 | 3.4 | 0 | 0.0 |
Country of birth | ||||||
Australia | 72 | 67.9 | 36 | 62.1 | 41 | 71.9 |
cOther | 34 | 30.7 | 22 | 37.7 | 15 | 26.3 |
Missing | 0 | 0.0 | 0 | 0.0 | 1 | 1.8 |
Aboriginal or Torres Strait Islander | ||||||
No | 106 | 100.0 | 57 | 98.3 | 57 | 100.0 |
Yes, Aboriginal | 0 | 0.0 | 1 | 1.7 | 0 | 0.0 |
Qualitative data
T0 (n = 88) | T1 (n = 89) | T2 (n = 76) | ||||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Age Range (in years) | ||||||
18–25 | 2 | 2.3 | 2 | 2.2 | 3 | 3.9 |
26–50 | 61 | 69.3 | 67 | 75.3 | 48 | 63.2 |
51–75 | 23 | 26.1 | 16 | 18.0 | 22 | 28.9 |
Missing | 2 | 2.3 | 4 | 4.5 | 3 | 3.9 |
Gender | ||||||
Female | 75 | 85.2 | 73 | 82.0 | 66 | 86.8 |
Male | 13 | 14.8 | 16 | 18.0 | 10 | 13.2 |
aRole | ||||||
Nursing Staff | 33 | 37.5 | 34 | 38.2 | 26 | 34.2 |
Medical Staff | 12 | 13.6 | 13 | 14.6 | 8 | 10.5 |
Allied Health and Clinical Trials Staff | 6 | 6.8 | 4 | 4.5 | 8 | 10.5 |
Administrative, technical support and non-clinical managers | 15 | 17.0 | 12 | 13.5 | 13 | 17.1 |
Psycho-social Staff | 22 | 25.0 | 26 | 29.2 | 21 | 27.6 |
Employment Status | ||||||
Full-time | 57 | 64.8 | 58 | 65.2 | 49 | 64.5 |
Part-time | 27 | 30.7 | 26 | 29.2 | 24 | 31.6 |
Part-time, independent contractor | 2 | 2.3 | 0 | 0.0 | 0 | 0.0 |
Full-time, independent contractor | 0 | 0.0 | 1 | 1.1 | 0 | 0.0 |
Missing | 2 | 2.3 | 4 | 4.5 | 3 | 3.9 |
Language spoken at home | ||||||
English | 77 | 87.5 | 74 | 83.1 | 65 | 85.5 |
bOther | 9 | 10.2 | 11 | 12.4 | 8 | 10.6 |
Missing | 2 | 2.3 | 4 | 4.5 | 3 | 3.9 |
Country of birth | ||||||
Australia | 62 | 70.5 | 58 | 65.2 | 52 | 68.4 |
cOther | 24 | 27.2 | 27 | 30.3 | 21 | 27.7 |
Missing | 2 | 2.3 | 4 | 4.5 | 3 | 3.9 |
Aboriginal or Torres Strait Islander | ||||||
No | 85 | 96.6 | 84 | 94.4 | 73 | 96.1 |
Yes, Aboriginal | 1 | 1.1 | 1 | 1.1 | 0 | 0.0 |
Missing | 2 | 2.3 | 4 | 4.5 | 3 | 3.9 |
1. Mental health is an important issue which ADAPT addresses
“everybody that has a cancer diagnosis will have some degree of anxiety and will need some support, and when they need a lot of support that needs to be identified quickly...” (C_ADMIN_S01P07T1)
“It’s been one of the areas that’s been quite lacking, as far as, support for patients in this area. So I think that’s something that everybody is very excited about.” (E_NURS_S02P09T0)
“I think it’s really useful and very evidence-based … it’s actually reassuring that what we’re doing is actually evidence-based.” (E_NURS_S08P01T0)
“At the moment, we deal with anxiety and depression but it’s really ad hoc - sometimes we’re hit and miss. Because there could be patients that don’t show they're anxious or have any depression … and they just soldier on. This way … we’re going to pick up a lot more.” (E_ADMIN_S02P05T0)
“We've picked up some things that wouldn't have, ordinarily, been picked up … and been able to provide services for those patients.” (E_AH_S03P06T2)
“I think in my service in particular it is not exactly necessary … we are finding that a lot of the patients that are screening positive through the portal are already in touch with our psychology service.” (C_NURS_S11P03T1)
“So far all of the patients who’ve been identified are patients who are already known to us. So, so far the utility of it probably hasn’t been particularly helpful.” (C_PSYCH_S11P01T1)
“So if we have a system to certify the patient needs that help and refer to them early rather than late. And then, I think, make them, the journey a little bit easy.” (C_NURS_S12P05T2)
“so it’s just that ADAPT– it’s just a slow moving beast. Whereas … the protocol that we had for distress … it allowed for quick reactions and referrals … rather than screen in a month and we’ll see where you’re up to … that just doesn’t seem to be a good fit for the surgical context.” (E_PSYCH_S07P01T1)
However, some staff felt that ADAPT could not overcome the stigma of mental health.“People can often put on a brave face … until … the actual conversation is facilitated … I feel the pathway’s actually brought a lot of opportunities for people to get help that may … not have reached out for help otherwise. Or they didn’t know how to reach out for help.” (C_NURS_S12P01T1)
“To be honest … I think the last report said that we only had one person screened and I, personally, just think it’s our area, our demographics. It’s the stigma that goes with it. And I don’t think that will ever change.” (E_NURS_S04P02T1)
2. ADAPT helps staff deliver best care, and reduces staff stress
“Two weeks ago the patient re-screened … and she screened high still … I was able to communicate with the doctor and offer her suggestions of what to do, and her treatment did change and she did have a better fortnight because of that.” (C_NURS_S12P01T1)
“They aren't asked early enough and then before we know it the patients have all these social issues at home and we're kind of on the back foot, we're not proactive about addressing it, we're just kind of reacting, so I definitely think the questions need to be asked.” (C_NURS_S01P06T1)
“I think the advantage will be that it will cut my load down … they can do the work themselves … through the resources, so I think that’s excellent.” (E_PSYCH_S05P01T0)
“ … the referral pathways are working... [prior to ADAPT] I would get contacted and then I would be the one trying to figure out what to do next and who else to involve.” (C_MED_S01P09T1)
3. ADAPT is fit for purpose, for both the cancer care setting and patients
“the way that I see it is, um, that it's not going to increase workloads, it's just going to formalise workloads. So what we're already doing will just be documented better.” (C_AH_S03P06T0)
“We don’t exactly know how to fit it into our normal routine just yet … it’s something new that we’ll have to adjust into our workflow. (E_NURS_S08P01T0)
“But at the end of the day there's only a certain number of hours in the day, and so many things to get done … fitting everything, has been difficult.” (C_MED_S01P09T2)
“We’ve found that it hasn’t been a very good fit for the patients that come through … They … come in, they have their operation, they go home. And so there's not that kind of ongoing continuity of care that ADAPT would be quite well suited for.” (E_PSYCH_S07P01T1)
“All three that spoke about it with me were grateful, one of them thought she didn’t need it but took our number and when she actually, when things got a bit hairy she gave us a call which I think is excellent … ” (E_PSYCH_S06P14T1)
“The men tend to be, you know, more macho and not able to really express their feelings … Country folk I think are very different your more metropolitan, city people.” (E_NURS_S02P04T0)
“We've had several patients who were quite distressed by the process … actually they’ve recorded that they found that quite anxiety inducing.” (C_PSYCH_S11P01T2)
“If you don’t speak English then … we can’t help you.” (E_NURS_S06P06T0)
“We actually have patients that sometimes we can’t even get in contact with because they have no phone and they have no computer. They’re living in a tent or a car.” (E_NURS_S04P02T0)
“Honestly, the patients have been more willing than some staff … even the elderly patients, they might need a bit of help with these new fandangle things, but … . after the first couple of questions, they get the gist of it and they’re fine, they just fly through” (C_AH_S03P02T2)
4. ADAPT: a catalyst for change
“showing that we definitely do need … some form of psychological service here for patients. I know there’s a need, but it’s good to see it in black and white always.” (C_NURS_S03P07T1)
“We probably have a better idea of how many people are actually needing a psychologist assessment so that maybe that will help us make a case to have a psychologist available for our service.” (C_MED_S01P09T1)
“Even within the corporate services, there seems to be, uh, not great communication. So we looked at this ADAPT trial as being quite a useful piece to help resolve that.” (C_ADMIN_S12P08T0)
“We knew that there would always be issues with the fact that we don't have a psycho-oncologist on site. But participating in ADAPT … made us explore alternatives to having a psycho-oncologist on site.” (C_MED_S01P09T2)
“We did establish a pathway, and I think once the staff here saw that we could actually do something about it, we’ve even had patients referred inbetween a screening … now that we’ve got the pathway there and we have the support services mapped out.” (C_AH_S03P02T2)