Development, acceptability and uptake of an on-line communication skills education program targeting challenging conversations for oncology health professionals related to identifying and responding to anxiety and depression
Authors: Shaw Joanne , Allison Karen , Cuddy Jessica , Lindsay Toni , Grimison Peter , Shepherd Heather , Butow Phyllis , Shaw Tim , Baychek Kate ,   The ADAPT Program Group, Allison Karen , Andrews Gavin , Baychek Kate , Beale Philip , Butow Phyllis , Clayton Josephine , Coll Joseph , Cuddy Jessica , Davies Fiona , Dhillon Haryana , Faris Mona , Geerligs Liesbeth , Girgis Afaf , Grimison Peter , Hack Tom , Harris Marnie , He Sharon , Kelly Brian , Kirsten Laura , Lindsay Toni , Lovell Melanie , Luckett Tim , Masya Lindy , Murphy Michael , Newby Jill , Orr Frances , Pearce Alison , Piro Don , Rankin Nicole , Shaw Joanne , Shaw Tim , Shepherd Heather , Stubbs John , Viney Rosalie , White Fiona , Yim Jackie , Kelly Brian 
Published: January 2022

Abstract
Background
Anxiety and depression screening and management in cancer settings occurs inconsistently in Australia. We developed a clinical pathway (ADAPT CP) to promote standardized assessment and response to affected patients and enhance uptake of psychosocial interventions. Health professional education is a common strategy utilised to support implementation of practice change interventions. We developed an interactive on-line education program to support staff communication and confidence with anxiety/depression screening and referral prior to the ADAPT CP being implemented in 12 oncology services participating in the ADAPT CP cluster randomised controlled trial (CRCT). The aim of this research was to assess acceptability and uptake of the education program.
Patient Involvement: Although the wider ADAPT Program included patient consumers on the Steering Committee, in the context of this research consumer engagement included health professionals working in oncology. These consumers contributed to resource development.

Methods
Development was informed by oncology and communication literature. The five online modules were pilot tested with 12 oncology nurses who participated in standardised medical simulations. Acceptability and uptake were assessed across the 12 Oncology services participating in the ADAPT CRCT.

Results
During pilot testing the online training was reported to be acceptable and overall communication and confidence improved for all participants post training. However, during the ADAPT CRCT uptake was low (7%; n = 20). Although those who accessed the training reported it to be valuable, competing demands and the online format reportedly limited HPs’ capacity and willingness to undertake training.

Conclusions
This interactive on-line training provides strategies and communication skills for front-line staff to guide important conversations about psychosocial screening and referral. Building workforce skills, knowledge and confidence is crucial for the successful implementation of practice change interventions. However, despite being acceptable during pilot testing, low uptake in real world settings highlights that organisational support and incentivisation for frontline staff to undertake training are critical for wider engagement. A multimodal approach to delivery of training to cater for staff preferences for face to face and/or online training may maximise uptake and increase effectiveness of training interventions.

Trial registration
Pilot study ACTRN12616001490460 (27/10/2016). ADAPT RCT ACTRN12617000411347(22/03/2017).