Implementing physical activity programs for patients with cancer in current practice: patients’ experienced barriers and facilitators

IJsbrandy, Charlotte; Hermens, Rosella; Boerboom, Laura W. M.; Gerritsen, Winald R.; Harten, Wim H. van; Ottevanger, Petronella B.

doi:10.1007/s11764-019-00789-3

Cited by 33 publications

(40 citation statements)

References 71 publications

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“…Knowledge and understanding of the determinants of adherence to evidence-based PCR guideline-based indicators in the present study, together with previously published studies assessing the barriers of adherence to evidence-based PCR guidelines [ 77 , 78 ], can assist HCPs in developing tailored strategies which can lead to improved adherence to PCR guidelines [ 75 ] by considering current practice as well as determinants of and barriers to adherence.…”

Section: Discussionmentioning

confidence: 89%

“…This results in interactive, coordinated care; therefore, we only explored determinants of the cancer centers. However, there may be compelling reasons for both lack of adherence and adherence due to determinants of the individual HCPs, particularly because HCPs' limited knowledge and skill levels, negative approach, non-commitment to PCRPs, difference in attitude about timing and strategies for cancer rehabilitation, and fear of additional workload all hinder proper PCR care [77,78,145,146]. On the level of the referring providers, limited knowledge levels concerning PCRPs and PCR guidelines hinder proper screening of patients.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Moreover, lack of knowledge and skills among HCPs resulted in a lack of qualified information provision for the patients. It also resulted in a lack of guidance in finding the right PCRP and a successful referral for joining the PCRP, both being barriers that impede proper PCR care [77,78,145,146].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…To design tailored implementation strategies, we used the stepwise theoretical framework of Grol and Wensing's "Implementation of Change Model" [75,76]. In doing so, we gained insight into current practice, potential determinants that predict adherence, and possible barriers and facilitators [77,78] influencing PCR guideline implementation. Determinants and barriers often arise at multiple levels within the healthcare system (at the patient, healthcare provider (HCP), cancer center, and healthcare organization levels) [79].…”

Section: Introductionmentioning

confidence: 99%

“…Determinants and barriers often arise at multiple levels within the healthcare system (at the patient, healthcare provider (HCP), cancer center, and healthcare organization levels) [79]. To assess the barriers, we performed two earlier studies [77,78]. We found multiple barriers at the level of PCR guidelines, PCRPs, and patients, but also at the level of HCPs, healthcare organization, and governance.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

et al. 2020

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Purpose To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. Methods We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). Results Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47–2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31–2.45), referral to PCRPs (OR 1.81, 95% CI 1.18–2.78), participation in PCRPs (OR 2.04, 95% CI 1.43–2.91), and PAU (OR 1.69, 95% CI 1.25–2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. Conclusions The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. Implications for Cancer Survivors Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.

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Section: Discussionmentioning

confidence: 89%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

et al. 2020

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The feasibility and acceptability of an app‐based intervention with brief behavioural support (APPROACH) to promote brisk walking in people diagnosed with breast, prostate and colorectal cancer in the UK

Lally,

Kennedy,

Smith

et al. 2024

Cancer Medicine

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IntroductionIncreased moderate to vigorous physical activity (MVPA) can improve clinical and psychosocial outcomes for people living with and beyond cancer (LWBC). This study aimed to assess the feasibility and acceptability of trial procedures in a pilot randomised controlled trial (RCT) of a theory‐driven app‐based intervention with behavioural support focused on promoting brisk walking (a form of MVPA) in people LWBC (APPROACH).MethodsParticipants diagnosed with breast, prostate or colorectal cancer were recruited from a single UK hospital site. Assessments at baseline and 3 months included online questionnaires, device‐measured brisk walking (activPAL accelerometer) and self‐reported weight and height. Participants were randomised to intervention or control (care as usual). The intervention comprised a non‐cancer‐specific app to promote brisk walking (National Health Service ‘Active 10’) augmented with print information about habit formation, a walking planner and two behavioural support telephone calls. Feasibility and acceptability of trial procedures were explored. Initial estimates for physical activity informed a power calculation for a phase III RCT. A preliminary health economics analysis was conducted.ResultsOf those medically eligible, 369/577 (64%) were willing to answer further eligibility questions and 90/148 (61%) of those eligible were enrolled. Feasibility outcomes, including retention (97%), assessment completion rates (>86%) and app download rates in the intervention group (96%), suggest that the trial procedures are acceptable and that the intervention is feasible. The phase III RCT will require 472 participants to be randomised. As expected, the preliminary health economic analyses indicate a high level of uncertainty around the cost‐effectiveness of the intervention.ConclusionsThis pilot study demonstrates that a large trial of the brisk walking intervention with behavioural support is both feasible and acceptable to people LWBC. The results support progression onto a confirmatory phase III trial to determine the efficacy and cost‐effectiveness of the intervention.

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Healthcare professionals’ perspectives of barriers and facilitators in implementing physical activity programmes delivered to cancer survivors in a shared-care model: a qualitative study

IJsbrandy

Harten

Gerritsen

et al. 2019

Support Care Cancer

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Background The positive impact of physical activity programmes has been recognised, but the current uptake is low. Authorities believe delivering these programmes in a shared-care model is a future perspective. The present study aimed to identify the barriers and facilitators affecting physical activity programme implementation in a shared-care model delivered with the cooperation of all the types of healthcare professionals involved. Methods Thirty-one individual interviews with primary healthcare professionals (PHPs) and four focus group interviews with 39 secondary healthcare professionals (SHPs) were undertaken. We used Grol and Flottorp's theoretical models to identify barriers and facilitators in six domains: (1) physical activity programmes, (2) patients, (3) healthcare professionals, (4) social setting, (5) organisation and (6) law and governance. Results In the domain of physical activity programmes, those physical activity programmes that were non-tailored to the patients' needs impeded successful implementation. In the domain of healthcare professionals, the knowledge and skills pertaining to physical activity programmes and non-commitment of healthcare professionals impeded implementation. HCPs expressed their concerns about the negative influence of the patient's social network. Most barriers occurred in the domain of organisation. The PHPs and SHPs raised concerns about ineffective collaboration and networks between hospitals. Only the PHPs raised concerns about poor communication, indeterminate roles, and lack of collaboration with SHPs. Insufficient and unclear insurance coverage of physical activity programmes was a barrier in the domain of law and governance. Conclusions Improving the domain of organisation seems the most challenging because the collaboration, communication, networks, and interactive roles between the PHPs and SHPs are all inadequate. Survivor care plans, more use of health information technology, improved rehabilitation guidelines, and better networks might benefit implementing physical activity programmes.

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Implementing physical activity programs for patients with cancer in current practice: patients’ experienced barriers and facilitators

Cited by 33 publications

References 71 publications

Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

The feasibility and acceptability of an app‐based intervention with brief behavioural support (APPROACH) to promote brisk walking in people diagnosed with breast, prostate and colorectal cancer in the UK

Healthcare professionals’ perspectives of barriers and facilitators in implementing physical activity programmes delivered to cancer survivors in a shared-care model: a qualitative study

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