Barriers and Enablers to Community-Based Psycho-oncology: A Qualitative Study of Health Professionals' Attitudes to the Feasibility and Acceptability of a Shared Care Model

Psychological therapies combined with medication are effective treatments for depression and anxiety in patients with cancer. However, the psycho-oncology workforce is insufficient to meet patient need and is hard to access outside of major cities. To bridge this gap, innovative models of care are required. Implementation of a new model of care requires attention to the facilitators and barriers. The aim of this study was to explore stakeholders' attitudes to the feasibility and acceptability of a community-based, shared care model for the treatment of depression and anxiety. Semi-structured interviews were conducted with community-based clinical psychologists (n=10), general practitioners (n=6) and hospital-based psychologists working in psycho-oncology (n=9). Framework analysis was conducted to identify key themes. All stakeholders perceived the model as feasible and acceptable. Potential barriers/facilitators to implementation were summarised under six key themes: (1) initiative, ownership and autonomy, (2) resources, (3) pathway establishment, (4) support, (5) skill acquisition, and (6) patient engagement. Facilitators included quality communication between health professionals across primary and tertiary care, and appropriate education and support for community-based clinicians. This in-depth exploration of Australian health professionals' perceptions of the feasibility and acceptability of a community-based model of psycho-oncology care revealed that most clinicians were willing to adopt the proposed changes into practice. An RCT of a shared care intervention for depressed patients with cancer is needed.