Evaluation of a Program for Routine Implementation of Symptom Distress Screening and Referral in Cancer Care

Change in referral uptake

The secondary outcome is the change in uptake of the referral, i.e. the proportion of referred patients accepting services.

Time frame: Pre- and post-implementation phase, up to 24 months

Process evaluation in providers by conducting qualitative interviews

Using qualitative approach with service providers (i.e. the nurses) to identify facilitators and barriers for the implementation of the symptom distress screening program, as well as their overall experience. All nursing staff from the study units involved in the symptom distress screening will be invited to join the qualitative study at the post-implementation phase.

Time frame: post-implementation phase, up to 24 months

Process evaluation in patients by conducting qualitative interviews

We will also conduct qualitative interviews to explore patients' experiences with symptom distress screening and referral if appropriate. Patients who are referred for support services will be approached by the research assistant who will explain the purpose of the study and nature of participation, with an emphasis on confidentiality and anonymity. If agreeing to participate, the RA will obtain a written consent and each subject will subsequently participate in in-depth interview by a trained interviewer. For patients who decline to be referred for support services, we will ask the nursing staff to invite the patients to join the qualitative study. We will recruit patients from both implementation and control conditions as it will enable us to compare patients' experienc.

Time frame: post-implementation phase, up to 24 months

Number of staff receiving training

All nurses will first receive a half-day training on how to administer the symptom distress screening tool, evaluate patients' reported symptom distress, refer patients to and follow-up for referred patients. We will record the number of invited staff attending the half-day training workshop.

Time frame: pre-implementation phase, up to 24 months

Change in staff knowledge about the implementation of the screening programme assessed using categorical Likert scales

We will assess the staff knowledge at pre- and post-training workshop and again at the end of the implementation study using a 6 points-categorical Likert scale (0-5) for participants' knowledge about the implementation of the screening program. Such information will be served as implementation indicators to facilitate the interpretation of the study findings.

Time frame: pre- and post-training workshop, and post-implementation phase, up to 24 months

Change in staff's belief in the symptom distress screening programme assessed using categorical Likert scales

We will assess the staff's belief at pre- and post-training workshop and again at the end of the implementation study using a 6 points-categorical Likert scale (0-5) for participants' beliefs towards the symptom distress screening programme. Such information will be served as implementation indicators to facilitate the interpretation of the study findings.

Time frame: pre- and post-training workshop, and post-implementation phase, up to 24 months

Change in staff self-efficacy in administrating the symptom distress screening programme assessed using categorical Likert scales

We will assess the staff's self-efficacy at pre- and post-training workshop and again at the end of the implementation study using a 6 points-categorical Likert scale (0-5). Such information will be served as implementation indicators to facilitate the interpretation of the study findings.

Time frame: pre- and post-training workshop, and post-implementation phase, up to 24 months