Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): study protocol for a cluster-randomized comparative effectiveness trial

Abstract

Background: Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation. Method: The PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when training (strategy I) is combined with implementation expanded resources (strategy II). There are three aims: (1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; (2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster-randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost-effective use of resources consistent with family risk (institution); (3) Based on the results of the

Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

“…While qualitative approaches to engage stakeholders in optimizing implementation strategies are well-documented, few reports detail how stakeholder input is used to do so when strategies are linked to multiple theoretical underpinnings and to long-standing programs of research focused on health equity [ 10 , 16 , 18 , 19 ]. This paper makes substantive and methodological contributions to addressing these gaps in the science.…”

“…Implementing the PAT, a well-validated psychosocial screening tool that assesses multiple areas of family psychosocial risks and resources related to social determinants of health, in a national sample in pediatric cancer is novel and has the potential to have an important impact on health equity [ 16 ]. Building from considerable evidence about acceptability and feasibility of PAT implementation in clinical practice, this project focused on the first component of the implementation process: preparation.…”

“…To advance the goal of universal family psychosocial risk screening in pediatric cancer centers and reduce health inequities, we used the Interactive Systems Framework for Dissemination and Implementation (ISF) [ 15 ]. The ISF describes three steps (systems) needed to bridge the gap between science and practice by understanding the barriers and resources of the different systems to consider when optimizing implementation strategies [ 16 ]. Our broader program of research on the implementation of the PAT utilizes all three steps of the ISF.…”

“…This paper describes the first step (Prevention Synthesis and Translation) in which the perspectives of key stakeholders were gathered to refine the two implementation strategies to enhance their effectiveness for testing in the subsequent implementation trial. In the second step (Prevention Support System of the ISF), a cluster randomized implementation trial in 18 pediatric cancer programs compares two PAT implementation strategies selected based on prior research and on the Expert Recommendations for Implementing Change (ERIC) [15][16][17]. Strategy I is a training webinar that addresses family psychosocial adjustment in pediatric cancer, pediatric psychosocial standards of care, the PPPHM Model, description of the PAT, details of using the PAT, and development of an Implementation Plan for using the PAT.…”

Evaluation Of The Parents’ Anxiety Levels Before And After The Diagnosis Of Their Child With A Rare Genetic Disease: The Necessity Of Psychological Support

“…Psychosocial Assessment Tool (PAT) is another successful example that can be used to determine the family's psychosocial status [31]. For further studies, variable tests can be used together with the STAI form to assess the requirement of psychological support for parents.…”