Implementing Strength after Breast Cancer (SABC) in outpatient rehabilitation clinics: mapping clinician survey data onto key implementation outcomes

Abstract

Background: While 3.5 million breast cancer survivors in the USA are indicative of promising disease-free survival, many experience adverse effects in recovering from treatment. Evidence-based exercise programs may be a lowcost, easily disseminable solution to the challenge of recovering from adverse treatment affects. Therefore, after establishing efficacy in a large randomized controlled trial, we developed the Strength after Breast Cancer (SABC) program and the accompanying online course for clinicians interested in physical therapy to learn to deliver this rehabilitative exercise program to individuals with breast cancer. We surveyed clinicians who took the course to assess implementation of the program in outpatient rehabilitation clinics. Methods: Ninety-six clinicians completed the survey between June and December, 2017 (24% response). Guided by Proctor's implementation outcomes framework, the respondents were asked if they had implemented (adoption) and are still implementing the program (sustainability), and which programmatic components they implemented (fidelity). Respondents were asked how many patients completed the program (reach), how patients got into the program (reach), the program's delivery format (appropriateness), and whether clinics were reimbursed by third-party payers (cost). Finally, respondents were asked what barriers they faced in delivery of SABC (feasibility) and whether others in the clinic completed the course (penetration). Results: Seventy-six percent of respondents implemented SABC and among those, 93% (68/73) were still delivering it. All programmatic components were implemented by over two thirds of respondents (67-95%). On average, the program was delivered to 13 patients per clinic by the time respondents took the survey. Most patient referrals were from oncology clinics (50%). The majority of clinicians delivered SABC one-on-one (96%) and 72% of clinics were compensated via third-party payers. Major barriers were lack of referrals from oncologists (40%) and clinic's competing demands (33%). We found no differences (Fisher's exact test p > .05) in reported barriers between those who implemented the program and those who did not.

Community-Based Exercise Programs for Cancer Survivors: A Scoping Review of Program Characteristics Using the Consolidated Framework for Implementation Research

“…Over half of publications (53%) reported on changes in physiological or psychosocial outcomes as a result of taking part in the program through single-group pre-post or randomized controlled trial design 25, 35-38, 41, 43-46, 48, 53, 54, 56, 58-61, 65-71, 73-78 . Others (21%) primarily focused on describing program development and implementation 24,32,33,38,40,47,50,52,57,63,72,80 . Thirteen publications (22%) reported participants' experiences in community-based exercise programs using a qualitative 27,30,31,49,51,55,62,64,69,81 or cross-sectional survey design 29,34,75 ; two (3%) were study protocol papers 39,79 and two (3%) described hybrid implementation-effectiveness trials 26,28 .…”

“…The primary purposes of 14 out of 58 included publications was to report on program development and implementation and/or implementation outcomes 24, 26, 32, 33, 35, 38-40, 42, 47, 50, 57, 72, 80 . The RE-AIM framework guided the evaluation of five (15%) programs 28,38,39,42,57 , and Proctor's Implementation Outcomes Framework 84 guided two evaluations 33,72 . Other implementation-related outcomes included acceptability at the patient or provider level (35%) 24, 26, 27, 34-36, 50, 57-59, 64, 73, 75, 77, 80, 81 , adoption (26%) 26, 39, 46-48, 53, 54, 57-59, 74, 76, 77 , costs (12%) 26,28,39,57 and feasibility (6%) 26,62,63 .…”

Characteristics and impact of interventions to support healthcare providers’ compliance with guideline recommendations for breast cancer: a systematic literature review

“…Most (86%) were published from 2000 onwards. The studies were conducted in six countries: 15 (42%) were conducted in USA [ 37 , 44 – 46 , 49 – 51 , 53 – 58 , 60 , 70 ], 12 (34%) in France [ 38 – 43 , 63 – 68 ], 3 (9%) in the Netherlands [ 52 , 62 , 69 ], and 3 (9%) in Canada [ 36 , 59 , 61 ]. The remaining two studies were conducted in Australia [ 47 ], and Italy [ 48 ].…”

“…Eleven studies described interventions to support compliance with guidelines on diagnosis and treatment [ 41 , 43 , 52 , 56 , 64 – 70 ], 9 focused on treatment only [ 38 – 40 , 42 , 47 – 49 , 62 , 63 ], 5 on diagnosis only [ 45 , 51 , 58 – 60 ], and 7 on screening [ 36 , 37 , 46 , 50 , 54 , 57 , 61 ]. Six studies were randomized controlled trials [ 37 , 45 , 50 , 51 , 54 , 60 ], four were non-randomized controlled trials [ 46 , 57 , 58 , 63 ], eight non-controlled before-after studies [ 42 , 49 , 53 , 55 , 59 , 62 , 65 , 69 ], one prospective cohort study , three cross-sectional studies [ 44 , 47 , 56 ], one mixed-methods [ 36 ] and twelve case studies [ 38 – 41 , 43 , 48 , 52 , 61 , 64 , 66 – 68 ].…”

Studying the Implementation of Exercise Oncology Interventions: A Path Forward

“…The primary takeaway from the implementation of the SABC program in the health care setting is that a toolkit, champions, and technical assistance are crucial to success. The SABC program is still covered by third party payers, the toolkit has been commercialized as a Web-based training, and SABC is offered in over 1000 locations across the United States and beyond (38). A consistent, ongoing challenge is getting oncologists to refer patients into the program.…”