Bridging the research to practice gap: a systematic scoping review of implementation of interventions for cancer-related fatigue management

Abstract

Background Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in people with cancer. Although efficacy of interventions for CRF have been extensively investigated, less has been done to ensure successful translation into routine clinical practice. The aim of this systematic scoping review was to synthesise knowledge surrounding the implementation of CRF interventions, summarise the processes and outcomes of implementation strategies used, and identify opportunities for further research. Methods PubMed, Cochrane CENTRAL, EMBASE and CINAHL databases were searched (up to December 2020). The Cochrane Effective Practice and Organisation of Care (EPOC) Group taxonomy and the RE-AIM Framework were used to guide the evaluation of implementation strategies and outcomes, respectively. Results Six studies were included. Three used an implementation framework (PARIHS, KTA, Cullens & Adams’ Implementation Guide) to guide implementation. Overall, the implementation strategies used across all studies were reported to have directly resulted in immediate changes at the clinician level (e.g., increased clinician behaviours, self-efficacy, attitudes, knowledge of CRF management). No clear relationship was found between the use of implementation models and the number or type of implementation strategies used. For outcomes, Effectiveness and Implementation were the most highly reported RE-AIM measures followed by Reach then Maintenance. Adoption was the least reported. Conclusions Despite the high prevalence of CRF and evidence-based interventions for managing CRF, there is limited evidence informing the sustainable implementation of these interventions. This systematic scoping review emphasises the lack of quality CRF implementation studies presently available in the literature leading to a disconnect between effective CRF interventions, routine clinical care, and cancer survivors at present. This review highlights the need for robust study designs guided by established frameworks to methodically design and evaluate the implementation of CRF management interventions in the future.

Non-pharmacological interventions for self-management of fatigue in adults: An umbrella review of potential interventions to support patients recovering from critical illness

“…Most reviews focused on cancer-related fatigue (n = 8), with the remaining reviews addressing post-viral fatigue (n = 1) and Systemic Lupus Erythematosus (SLE) (n = 1). Four reviews focused exclusively on fatigue [23][24][25][26] and six on a range of symptoms including fatigue [22,[27][28][29][30][31]. A wide range of interventions were included in the reviews, including lifestyle (e.g.…”

“…Only self-management summary data were extracted. Half of included reviews (n = 4) focused exclusively on self-management [22][23][24]27]. Across the primary studies, a total of 31 different outcome measures were used to measure fatigue as a primary outcome (Supplementary File 2).…”

Telehealth cancer-related fatigue clinic model for cancer survivors: a pilot randomised controlled trial protocol (the T-CRF trial)

“…1 2 A recent scoping review on the implementation of CRF management strategies into clinical practice identified a lack of high-quality studies in the literature which also highlights the disconnect between effective CRF interventions and routine clinical care. 23 As a key implementation strategy, the concept of a 'CRF clinic' is one successful method to facilitate the systematic assessment and management of CRF in cancer survivors. 24 25 These clinics are often physician-led, provided in well-resourced centres, and require cancer survivors to attend face-toface appointments at the cancer centre.…”

The Effects of Transcutaneous Acupoint Electrical Stimulation on Cancer‐related Fatigue and Negative Emotions in Cancer Patients: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

“…For instance, 30-60% of cancer patients undergoing treatment reportedly develop severe cancer-related fatigue (CRF), which can lead to treatment interruption because of poor results from reduced physical function and reduced motor capacity [1]. Fatigue usually decreases within a year after treatment completion, but CRF is expected to last for months or even years in a small subset of patients after successful treatment [2]. In addition, cancer patients may develop serious negative emotions such as depression and anxiety, which further adversely affect the overall quality of life.…”