Psycho-Oncology Co-Operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
BMC Health Serv Res. 2023 Aug 15;23(1):866. doi: 10.1186/s12913-023-09829-2.
Organisational readiness is recognised as a key factor impacting the successful translation of research findings into practice. Within psycho-oncology, measuring organisational readiness and understanding factors impacting organisational readiness is crucial as it is often challenging to implement evidence-based findings into routine cancer care. In this quantitative study, we examined the level of organisational readiness of cancer services preparing to implement a clinical pathway for the screening, assessment, and management of anxiety and depression in adult cancer patients (the ADAPT CP) within a cluster randomised controlled trial and sought to identify staff- and service-level factors associated with organisational readiness.
Multidisciplinary staff across 12 Australian cancer services were identified. Their perceptions of their services' readiness to implement the ADAPT CP in the cancer stream or treatment modality selected within their service was assessed prior to implementation using the Organizational Readiness for Implementing Change scale. Data collection included staff demographic and professional characteristics, and their perception of the ADAPT CP using a set of 13 study-specific survey items. Service characteristics were captured using a site profile audit form and workflows during site engagement.
Fourteen staff- and service-level factors were identified as potentially impacting organisational readiness. To identify factors that best explained organisational readiness, separate univariate analyses were conducted for each factor, followed by a backward elimination regression. Compared to services that implemented the ADAPT CP in one treatment modality, those opting for four treatment modalities had significantly higher organisational readiness scores. Staff in administrative/technical support/non-clinical roles had significantly higher organisational readiness scores compared to psychosocial staff. Higher organisational readiness scores were also significantly related to more positive perceptions of the ADAPT CP.
Readiness to implement an anxiety and depression clinical pathway within 12 oncology services was high. This may be attributed to the extensive engagement with services prior to implementation. The factors associated with organisational readiness highlight the importance of ensuring adequate resourcing and supporting staff to implement change, effectively communicating the value of the change, and taking a whole-of-service approach to implementing the change. Future longitudinal studies may identify factors associated with ongoing readiness and engagement prior to implementation.
The ADAPT RCT was registered prospectively with the ANZCTR on 22/03/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true .
组织准备度被认为是影响研究结果成功转化为实践的关键因素。在心理肿瘤学中，衡量组织准备度并了解影响组织准备度的因素至关重要，因为将基于证据的发现纳入常规癌症护理往往具有挑战性。在这项定量研究中，我们检查了准备实施用于筛查、评估和管理成年癌症患者焦虑和抑郁的临床路径（ADAPT CP）的癌症服务的组织准备度水平，并试图确定与组织准备度相关的员工和服务水平因素。
在 12 个澳大利亚癌症服务机构中确定了多学科工作人员。在实施之前，使用组织变革实施准备量表评估他们对在癌症服务或在其服务中选择的治疗模式中实施 ADAPT CP 的服务准备程度。数据收集包括员工的人口统计学和专业特征，以及他们使用一套 13 项特定于研究的调查项目对 ADAPT CP 的看法。使用站点档案审核表和站点参与期间的工作流程来捕获服务特征。
确定了 14 个潜在影响组织准备度的员工和服务水平因素。为了确定最能解释组织准备度的因素，我们对每个因素分别进行了单变量分析，然后进行了向后消除回归。与在一种治疗模式中实施 ADAPT CP 的服务相比，选择四种治疗模式的服务具有更高的组织准备度得分。行政/技术支持/非临床角色的员工的组织准备度得分明显高于心理社会工作人员。更高的组织准备度得分与对 ADAPT CP 的更积极看法显著相关。
在 12 个肿瘤服务机构中实施焦虑和抑郁临床路径的准备度很高。这可能归因于在实施前与服务机构的广泛接触。与组织准备度相关的因素强调了确保提供足够资源和支持员工实施变革、有效沟通变革价值以及采取整体服务方法实施变革的重要性。未来的纵向研究可能会确定实施前与持续准备度和参与度相关的因素。
ADAPT RCT 于 2017 年 3 月 22 日在澳大利亚临床试验注册中心进行了前瞻性注册。试验 ID ACTRN12617000411347。https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true。
