Determinants of the implementation, integration, and sustainability of new non-professionally affiliated psychosocial support roles: a scoping review.

INTRODUCTION: There is an increasing drive to implement new non-professionally affiliated psychosocial support roles within multidisciplinary teams (MDT) to improve the integration of care. This is to enhance holistic care and extend the historic focus of care beyond the patient, to the family and community, however, determinants that impact on the implementation of these roles have yet to be reviewed. METHODS: The aim of the scoping review was to identify determinants impacting the implementation and sustainability of these roles within MDTs. The review was informed by the Joanna Briggs Institute framework and the 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis'. Using a pre-defined search strategy, CINAHL, Medline, PsycInfo, and Web of Science databases were searched. Identified studies were screened using Covidence ( www.covidence.org/ ). Data extraction and analysis involved three phases: data extraction using the Consolidation Framework for Implementation Research (CFIR); identifying and classifying determinants; developing explanatory themes beyond CFIR using thematic analysis. RESULTS: A total of 4232 papers remained after deduplication. Twenty-four papers met the inclusion criteria. Four themes were identified: new role boundaries; two sides to the worker - patient/client relationship; environmental preparedness; and role holder characteristics. Role boundary issues due to deficits in role clarity lack of training for the role holder, and information for wider team, were significant barriers to implementation and sustainability. Mentorship and training, which developed role holders' skills and confidence as well as role holders' personal characteristics, life experience, the flexibility of their role, and having time to spend with patients/clients were significant enablers. CONCLUSION: There is a need for greater attention to role clarity and boundary working during the design phase of roles and as an aspect of environmental preparedness, especially with MDT members. The provision of training specific to new roles, and support in the form of mentorship, are necessary to develop the required skills and confidence in new role holders. Given the considerable heterogeneity in the aims and objectives of research on new psychosocial roles not affiliated to a profession or discipline an absence of studies focusing on the determinants of the implementation, integration, and sustainability of these roles, more research is needed to support their future implementation.