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. Whilst 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 through 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 implementation frameworks (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. There was an absence of external indicator reporting (e.g., start-up and ongoing intervention costs) in included studies, limiting the transability of study findings. Further, factors such as lack of clinician time, insufficient program funding, and unsustainable maintenance costs, were highlighted as key implementation barriers of CRF programs. This scoping systematic 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. Further, this review also 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.

Impact of Cancer and 12 Weeks of Chemotherapy on the Balance of the Autonomic Nervous System in Cancer Patients

“…CFR differs from other types of fatigue in its persistence and severity, often described by patients as unbearable and insurmountable. CRF restricts patients and survivors in daily life (return to work, family life, return to sports and physical activity) and significantly reduces quality of life (Agbejule et al, 2021).…”