Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation

Hubbard, Gill; Campbell, Anna; Fisher, Abi; Harvie, Michelle; Maltinsky, Wendy; Mullen, Russell; Banks, Elspeth; Gracey, Jackie; Gorely, Trish; Munro, Julie; Ozakinci, Gözde

doi:10.1186/s40814-018-0297-1

Cited by 11 publications

(51 citation statements)

References 52 publications

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“…Forty-six barriers were described in 25 studies [24,79,38,44,48,50,32,34,35,36,41,43,46,50,52,54,55,56,57,59,68,69,72,73,74,76]. Innovation level barriers were described across two major categories: advantages in practice and accessibility.…”

Section: Innovationmentioning

confidence: 99%

“…The direct cost of an exercise program was highlighted as a barrier to participation by patients and to referral by HCPs, as described in 11 barriers across 11 studies [38,48,50,56,74,34,34,34,36,46,50]. For patients, direct participation costs were a concern for unsubsidised programs such as fitness centres [54,54,57]. One recently diagnosed patient stated simply "I couldn't afford to join a gym…" [76] (p. 1142).…”

Section: Accessibilitymentioning

confidence: 99%

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Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review

et al. 2021

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Purpose While calls have been made for exercise to become standard practice in oncology, barriers to implementation in real-world settings are not well described. This systematic scoping review aimed to comprehensively describe barriers impeding integration of exercise into routine oncology care within healthcare systems. Methods A systematic literature search was conducted across six electronic databases (since 2010) to identify barriers to implementing exercise into real-world settings. An ecological framework was used to classify barriers according to their respective level within the healthcare system. Results A total of 1,376 results were retrieved; 50 articles describing implementation barriers in real-world exercise oncology settings were reviewed. Two hundred and forty-three barriers were identified across all levels of the healthcare system. Nearly 40% of barriers existed at the organizational level (n = 93). Lack of structures to support exercise integration and absence of staff/resources to facilitate its delivery were the most common issues reported. Despite the frequency of barriers at the organizational level, organizational stakeholders were largely absent from the research. Conclusions Implementing exercise into routine cancer care is hindered by a web of interrelated barriers across all levels of the healthcare system. Organizational barriers are central to most issues. Future work should take an interdisciplinary approach to explore best practices for overcoming implementation barriers, with organizations as a central focus. Implications for Cancer Survivors This blueprint of implementation barriers highlights critical issues that need to be overcome to ensure people with cancer have access to the therapeutic benefits of exercise during treatment and beyond.

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Section: Innovationmentioning

confidence: 99%

Section: Accessibilitymentioning

confidence: 99%

Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review

et al. 2021

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“…The median number of consultations was 8, which is 66% of what was planned. This is higher than other telephone-delivered PA intervention trials of similar duration [53,54]. Nonetheless, the optimal number of consultations and duration (in weeks) required for a home-based PA programme to be effective is uncertain.…”

Section: Intervention Implementationmentioning

confidence: 89%

“…The study suggests that it is useful to give participants a choice of method for a PA consultation since half were face-to-face and the other half were by VC or telephone. The latter methods are important because a key barrier to PA is travel [54]. Diaries show that participants completed 10 weeks (83%) of the 12week prescribed PA programme, and 75% of prescribed exercises each week, suggesting that intervention adherence was high.…”

Section: Intervention Implementationmentioning

confidence: 99%

A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study

Hubbard

Taylor

Watson

et al. 2020

Pilot Feasibility Stud

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Background: We hypothesise that a physical activity (PA) intervention will improve the quality of life (QoL) of people with a stoma. A feasibility study of the intervention and trial parameters is necessary to inform a future main trial. Methods: Participants received a weekly PA consultation by telephone, video conferencing, or face-to-face for 12 weeks with a PA instructor who prescribed physical activities and supported participants by addressing stoma-related concerns and using behaviour change techniques. A feasibility study of the intervention and trial parameters was conducted in three UK sites using mixed methods. Results: The number of eligible patients consenting to the study was 30 out of 174 (17%). Most participants were female (73%); 73% had an ileostomy and 27% a colostomy; mean time since diagnosis was 6 months. A total of 18 (64%) participants completed pre-(baseline) and post-intervention (follow-up) measures. Results show an improvement on all scales measuring QoL and disease-specific fatigue. The median PA consultation rate per participant was eight sessions. Participants reported completing 75% or more of the prescribed PA each week. Eight stoma-related themes were identified from qualitative interviews: fear of hernia, bending down, fatigue, pain, prolapse, surgical wounds, stoma appliance, and stigma. The intervention appeared to address these issues. Conclusion: This feasibility study demonstrated that a novel manualised PA intervention for people with a stoma is safe, feasible, and acceptable, and shows promise for improving outcomes. However, difficulties with recruitment will need to be carefully considered to ensure the success of future studies in this area.

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“…The research team already have an idea of what the intervention will look like, which is based on their previous work with cancer patients, including people with bowel cancer [17, 18]. Nonetheless, an Expert Working Group of behavioural scientists, exercise scientists, clinicians and a Patient Advisory Group of people with a bowel stoma will meet with the research team to inform the development of a PA intervention for people with a stoma.…”

Section: Methodsmentioning

confidence: 99%

A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study protocol

Hubbard

Taylor

Watson

et al. 2019

Pilot Feasibility Stud

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Background Physical activity (PA) is positively associated with quality of life. People with a stoma are less likely to engage in PA than those without a stoma. Methods In this feasibility intervention study, we will perform the following: (1) Develop a PA intervention for people with a stoma. An Expert Working Group of behavioural scientists, exercise scientists, clinicians and a Patient Advisory Group of people with a bowel stoma will meet with the research team to inform the development of a PA intervention for people with a stoma. A manual of the intervention will be the main output. (2) Explore PA instructors’ experiences of delivering the PA intervention. PA instructors will record on paper the number of PA consultations with each patient and a researcher will interview the PA instructors about their experiences of delivering the intervention. (3) Assess the level of patient (bowel cancer or inflammatory bowel disease (IBD) patients with a stoma between 6 weeks and 24 months post-surgery) engagement with the PA intervention and their views on intervention acceptability and usefulness. Patients will keep a PA diary to record daily pedometer recorded step count and type and duration of activities. A researcher will interview patients about their experiences of the PA intervention. (4) Assess screening, eligibility, consent, data completion, loss to follow up, and missing data rates, representativeness of participants and potential treatment effects. A researcher will record on paper all study procedure parameters. Quality of life (stoma-quality of life; Functional Assessment of Cancer Therapy, Short IBD questionnaire), fatigue (FACIT fatigue scale) and PA (accelerometer) will be measured pre- and post-intervention in patients. For IBD patients only, blood will be taken to measure systemic inflammation. Discussion We hypothesise that a PA intervention will be an effective means of improving the quality of life of people with a stoma. Before embarking on a full randomised controlled trial to test this hypothesis, a PA intervention needs to be developed and a feasibility study of the proposed PA intervention conducted. Trial registration ISRCTN58613962, Protocol version: 0.1. 14 September 2017.

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Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation

Cited by 11 publications

References 52 publications

Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review

Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review

A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study

A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study protocol

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