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)

  • 26 October 2020
  • Author: CareSearch
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Geerligs L, Shepherd HL, Butow P, Shaw J, Masya L, Cuddy J; ADAPT Program Group, Rankin NM.

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.

The utilization of allied and community health services by cancer patients living in regional and remote geographical areas in Australia

  • 26 October 2020
  • Author: CareSearch
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Parikh DR, Diaz A, Bernardes C, De Ieso PB, Thachil T, Kar G, Stevens M, Garvey G.

Introduction:
Cancer patients in Australia's Northern Territory (NT) face unique challenges to accessing cancer-related community and allied health services (referred here as 'health services'). This is in part due to the NT's unique geographic, socioeconomic and demographic profile. This paper describes the use of health services by cancer patients in the NT.

Methods:
Adult cancer patients attending appointments at a cancer centre in Darwin, NT and who were diagnosed within the past five years were invited to participate in face-to-face interviews about their use of allied and community health services. A descriptive analysis of health services utilization was conducted.

Results:
Of the 76 participants interviewed, 63% identified as non-Indigenous, 53% female and 45% lived in very remote areas. Mean age at interview was 58.7 years (SD 13.2). Overall, 82% of participants utilized at least one health service since their cancer diagnosis. All Indigenous participants used at least one service, while 28% of non-Indigenous participants did not use any health service. The services most frequently used by participants were community services (42%) and information sources (40%).

Conclusion:
The findings from this study suggest there is variation in the type of community and allied health services used by NT cancer patients across clinical and demographic groups (including Indigenous status). Further qualitative enquiry is needed to better understand this variation, which may reflect differences in service preference, accessibility, health literacy of patients or patient engagement. Such knowledge may inform service delivery improvements to better support cancer patients through their cancer care pathway.

Integrated telehealth-assisted home-based specialist palliative care in rural Australia: A feasibility study

  • 26 October 2020
  • Author: CareSearch
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Jiang B, Bills M, Poon P.

Introduction:
This study assessed the feasibility of integrating telehealth-assisted home-based specialist palliative care (TH-SPC) into a rural community setting.

Methods:
This was a prospective mixed-methods pilot study conducted in rural Victoria, Australia. Newly engaged adult patients and their caregivers of a community palliative-care service received video consultations with metropolitan-located specialist palliative-care physicians, alongside standard care. Those eligible patients who failed to receive TH-SPC were treated as a control group upon analysis. Data were collected over three months and at 30 days prior to death. Feasibility outcomes included efficiency of process, user satisfaction, clinical outcome and health-care metrics.

Results:
A total of 21 patients completed the study, with an average age of 70.4 years and an average survival of 5.8 months. Fourteen patients received TH-SPC, and seven received standard care alone. Patient-caregiver feedback for TH-SPC showed a high level of overall satisfaction. Compared to standard care, the TH-SPC group demonstrated less functional decline from baseline at two weeks (Australia-modified Karnofsky Performance Status: -1.35 vs. -12.30, p = 0.067) and three months (8.48 vs. -10.79, p = 0.04) after the intervention. At 30 days prior to death, functional status remained better in the TH-SPC group, with fewer per capita community palliative-care nursing visits (5.46 vs. 9.32, effect size = 0.7), general practitioner visits (0.13 vs. 3.88, effect size = 1.34) and hospital admissions (0.02 vs. 0.2, effect size = 0.65).

Discussion:
TH-SPC was successfully integrated into rural community-based palliative care, with potential benefits in performance status preservation and health-care resource utilisation.

Health services costs for lung cancer care in Australia: Estimates from the 45 and Up Study

  • 26 October 2020
  • Author: CareSearch
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Goldsbury DE, Weber MF, Yap S, Rankin NM, Ngo P, Veerman L, Banks E, Canfell K, O'Connell DL.

Background:
Of all cancer types, healthcare for lung cancer is the third most costly in Australia, but there is little detailed information about these costs. Our aim was to provide detailed population-based estimates of health system costs for lung cancer care, as a benchmark prior to wider availability of targeted therapies/immunotherapy and to inform cost-effectiveness analyses of lung cancer screening and other interventions in Australia.

Methods:
Health system costs were estimated for incident lung cancers in the Australian 45 and Up Study cohort, diagnosed between recruitment (2006-2009) and 2013. Costs to June 2016 included services reimbursed via the Medicare Benefits Schedule, medicines reimbursed via the Pharmaceutical Benefits Scheme, inpatient hospitalisations, and emergency department presentations. Costs for cases and matched, cancer-free controls were compared to derive excess costs of care. Costs were disaggregated by patient and tumour characteristics. Data for more recent cases identified in hospital records provided preliminary information on targeted therapy/immunotherapy.

Results:
994 eligible cases were diagnosed with lung cancer 2006-2013; 51% and 74% died within one and three years respectively. Excess costs from one-year pre-diagnosis to three years post-diagnosis averaged ~$51,900 per case. Observed costs were higher for cases diagnosed at age 45-59 ($67,700) or 60-69 ($63,500), and lower for cases aged ≥80 ($29,500) and those with unspecified histology ($31,700) or unknown stage ($36,500). Factors associated with lower costs generally related to shorter survival: older age (p<0.0001), smoking (p<0.0001) and unknown stage (p = 0.002). There was no evidence of differences by year of diagnosis or sex (both p>0.50). For 465 cases diagnosed 2014-2015, 29% had subsidised molecular testing for targeted therapy/immunotherapy and 4% had subsidised targeted therapies.

Conclusions:
Lung cancer healthcare costs are strongly associated with survival-related factors. Costs appeared stable over the period 2006-2013. This study provides a framework for evaluating the health/economic impact of introducing lung cancer screening and other interventions in Australia.

Implementation Plan for the National Palliative Care Strategy 2018

  • 23 October 2020
  • Author: CareSearch
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On October 20, the Department of Health have released their Implementation Plan for the National Palliative Care Strategy 2018. Key to the plan are four action areas:

  1. Access to palliative care is increased, particularly for underserved populations.
  2. The collaboration and coordination of palliative care is improved.
  3. Advance care plans are being prepared by people affected by life limiting illnesses and used to facilitate shared decision-making across care settings.
  4. Nationally consistent data collection mechanisms are implemented and national public reporting is underway.

You can download the plan from the Department website.

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