Barriers and Facilitators to Implementing Psychosocial Distress Assessments in the Pediatric Oncology Setting Public Deposited

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Last Modified
  • March 19, 2019
Creator
  • Stanley, Mercedes
    • Affiliation: School of Nursing
Abstract
  • Objective. Our understanding of the barriers and facilitators to implementing psychosocial distress screening in pediatric oncology settings is limited. This capstone project explored perceptions of staff at a small pediatric oncology clinic about the barriers and facilitators to implementing psychosocial distress screening using the Psychosocial Assessment Tool (PAT) within their clinic. Methods. Sixteen semi-structured interviews were conducted with clinic staff in various roles (licensced professional counselor n=1, child life specialists n=2, nurse practitioners n=2, physicians n=3, registered nurses n=7 and social worker n=1). Inductive thematic analysis was used to identify and interpret themes. Using the PDSA cycle (Institute of Healthcare Improvement, 2016), further strategizing regarding implementation will be conducted. Results: Four main types of barriers to implementation emerged from the data: (1) patient family barriers including the ability to participate, reading level/language barrier, willingness to participate, fear of stigma, time; (2) staff barriers including time, lack of training/confidence, “buy-in,” ownership; (3) contextual factors including resources, clinic size, documentation and confidentiality; (4) PAT-related barriers related. Five main strategies to facilitate implementation also emerged from the data: (1) appeal to longstanding professional values; (2) formalize a process for universal screening; (3) use a team approach; (4) develop screening protocols and a resource guide that can inform referrals; (5) consult with other programs. While the participants were not asked to directly provide strategies to facilitate implementation, these data were interrelated with their responses regarding barriers and facilitators and should be used to help build an implememntation plan. Conclusions: All barriers and facilitators identified in adult oncology literature were presented in this capstone project, while additional barriers and facilitators were identified in the pediatric oncology clinic that was the project site. While many of the concepts presented are generalizable, individual clinical programs should perform analysis of the specific family, staff and contextual barriers and facilitators to implementing psychosocial distress screening at their sites. In doing so, optimally effective and implementable approaches to psychosocial distress screening can be devloped.
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  • In Copyright
Advisor
  • Waldrop, Julee
  • Santacroce, Sheila
  • Yopp, Justin
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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