Endorsed but unevenly embedded: Implementing UK pre-transplant psychological assessment guidelines - a UK-wide service evaluation.

In 2024, Anthony Nolan in the UK published the first guidance on pre-transplant psychological assessment for adults undergoing HSCT, endorsed by the Association of Clinical Psychologists UK. It recommends six components: embedded specialist support, timing, routine referral, psychosocial assessment, recording and sharing findings, and follow-up support. Nothing is yet known about whether transplant services have taken it up and we know guidelines usually need work to be implemented. We surveyed 32 UK HSCT professionals to find out which components they report in their services, and to identify what is helping or hindering the guidance becoming routine work, using implementation theory. Two findings seem worth the journal's attention. First, the pattern of adoption is uneven in a specific and reparable way: respondents commonly reported embedded psychology and guideline-informed assessment, but reported routine referral, followup, and the recording and sharing of findings much less often. Referral typically required a distress-screening threshold rather than being offered routinely, which is not what the guidance suggests. Second, and unusually for a study of guideline uptake, the shortfall does not appear to sit with clinicians. Using Normalisation Process Theory and the NoMAD instrument, we found strong individual understanding, perceived benefit and willingness to act, alongside weak shared cross-disciplinary understanding, insufficient resource, and unclear ownership of documentation. The implication for transplant centres is practical: protected psychological capacity is necessary but will not on its own produce routine assessment without agreed MDT processes for who records findings and where.