The value of real-world testing: a qualitative feasibility study to explore staff and organisational barriers and strategies to support implementation of a clinical pathway for the management of anxiety and depression in adult cancer patients
Authors: Geerligs Liesbeth , Shepherd Heather L. , Rankin Nicole M. , Masya Lindy , Shaw Joanne M. , Price Melanie A. , Dhillon Haryana , Dolan Colette , Prest Gabrielle ,   The ADAPT Program Group, Andrews Gavin , Baychek Kate , Beale Philip , Allison Karen , Clayton Josephine , Coll Joseph , Cuddy Jessica , Girgis Afaf , Grimison Peter , Hack Tom , Kelly Brian , Kirsten Laura , Lindsay Toni , Lovell Melanie , Luckett Tim , Murphy Michael , Newby Jill , Orr Frances , Pearce Alison , Piro Don , Shaw Tim , Stubbs John , Viney Rosalie , White Fiona , Yim Jackie , Butow Phyllis 
Published: July 2020

Abstract
Background
Effective translation of evidence-based research into clinical practice requires assessment of the many factors that can impact implementation success. Research methods that draw on recognised implementation frameworks, such as the Promoting Action Research in Health Services (PARiHS) framework, and that test feasibility to gain information prior to full-scale roll-out, can support a more structured approach to implementation.

Objective
This paper presents qualitative findings from a feasibility study in one cancer service of an online portal to operationalise a clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients. The aim of this study was to explore staff perspectives on the feasibility and acceptance of a range of strategies to support implementation in order to inform the full-scale roll-out.

Methods
Semi-structured interviews were conducted with fifteen hospital staff holding a range of clinical, administrative and managerial roles, and with differing levels of exposure to the pathway. Qualitative data were analysed thematically, and themes were subsequently organised within the constructs of the PARiHS framework.

Results
Barriers and facilitators that affected the feasibility of the online portal and implementation strategies were organised across eight key themes: staff perceptions, culture, external influences, attitudes to psychosocial care, intervention fit, familiarity, burden and engagement. These themes mapped to the PARiHS framework’s three domains of evidence, context and facilitation.

Conclusions
Implementation success may be threatened by a range of factors related to the real-world context, perceptions of the intervention (evidence) and the process by which it is introduced (facilitation). Feasibility testing of implementation strategies can provide unique insights into issues likely to influence full-scale implementation, allowing for early tailoring and more effective facilitation which may save time, money and effort in the long-term. Use of a determinant implementation framework can assist researchers to synthesise and effectively respond to barriers as they arise. While the current feasibility study related to a specific implementation, strategies such as regular engagement with local stakeholders, and discussion of barriers arising in real-time during early testing is likely to be of benefit to all researchers and clinicians seeking to maximise the likelihood of long-term implementation success.