Anxiety and depression, the third largest cause of disability in Australia, is significantly higher in cancer patients. The ADAPT Program grant is funded to implement the clinical pathway for the screening, assessment and management of anxiety and depression in adults with cancer into routine cancer care. ADAPT aims to tackle issues of ownership; resources and responsibility; education and training, patient reluctance; and integration with health services.
Methods: Review of current implementation science literature and screening practices identified the need for resources to address staff and patient management requirements, provide education to support skills development and provide evidence-based interventions to address identified need. Supporting resources include: An online management system (ADAPTPortal) with validated online screening questionnaires, alerts when anxiety/depression is elevated, referral templates and evidence-based stepped-care management recommendations; an online health professional education program using evidence-based learning principles; patient information to normalise screening with links to existing resources for anxiety and depression, and; online psychological therapy programs (iCanADAPT) for patients with early or advanced cancer.
Results: The resources developed used evidence-based principles from implementation science, health professional education, health literacy and internet based psychological intervention research. The ADAPT Portal addressed the issue of integration beyond cancer services, by including community-based referral pathways. Allowing tailoring of the clinical pathway to service and staff capacity reflects available interventions and addresses local ownership and responsibility. The health professional education responded to the demand for education to support screening, referral recommendations and referral reluctance/refusal conversations. The qualitatively evaluted patient information addressed patient reluctance. The iCanADAPT programs being evaluated in RCT and pre-post studies provide an accessible evidence–based intervention appropriate for patients with moderate levels of anxiety/depression.
Conclusions: Implementing screening for anxiety/depression is hindered by concern about meeting previously unidentified need. Evidence-based resources to address known barriers are key to implementation success and sustainability.