An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology

Abstract

Background Clinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow. Methods For this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed. Results Initial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants’ performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility). Conclusions Implementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment.

Adopting a systems-thinking approach to optimise dietary and exercise referral practices for cancer survivors

“…In order to address similar concerns in the provision of dietary and exercise support, previous approaches include raising awareness among cancer survivors and their healthcare professionals about the benefits of diet and exercise, engaging stakeholders for their buy-in within different clinical organisations, implementing validated triage tools, and integrating referrals into the survivorship care plan and/or electronic records [ 15 – 17 ]. Consensus for the essential elements of diet and exercise referral practices has also been developed [ 18 ].…”