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.
Support Care Cancer. 2021 Jun;29(6):3235-3244. doi: 10.1007/s00520-020-05836-9. Epub 2020 Oct 23.
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).
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.
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.
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.
将循证心理肿瘤学干预措施转化为常规护理可以显著改善患者的结局，但由于存在众多现实障碍，有效的实施仍然具有挑战性。可能影响实施的一个关键因素是组织对变革的准备情况。这项混合方法研究旨在确定与实施澳大利亚成人癌症患者焦虑和抑郁筛查、评估和管理临床路径（ADAPT CP）相关的组织准备因素。
我们从准备实施 ADAPT CP 的六家澳大利亚癌症服务机构的多学科工作人员那里收集数据。根据组织实施变革准备度（ORIC）问卷（得分范围为 12-60）的中位数分割，将服务分为“高”和“中”组织准备度。基于促进卫生服务中的行动研究（PARiHS）框架的半结构化访谈的定性数据进行了主题分析，并比较了高组织准备度和中组织准备度服务之间的差异。
确定了三个高组织准备度（ORIC 范围分别为 52.25-56.88）和三个中组织准备度（范围为 38.75-46.39）的服务。报告准备程度较高的服务的工作人员描述了一种更具协作性和积极性的服务文化、强大的沟通流程和更大的角色灵活性。他们还报告说，对克服预期障碍更有信心，并且有更清晰的策略来解决问题。
组织准备程度与不同的定性主题有关。在全面推出之前，针对准备程度中等或较低的服务解决这些问题，可能会提高工作人员实施心理肿瘤学干预措施的信心和效力。
