Studying the Implementation of Exercise Oncology Interventions: A Path Forward

Abstract

Introduction/Purpose Extensive scientific evidence supports exercise benefits after a cancer diagnosis, and the field now needs to focus on elucidating effective strategies for implementing exercise evidence-based interventions (EBIs) for cancer survivors. Methods This article brings together three implementation efforts to describe pragmatic observations and strategies when implementing exercise oncology EBIs in nonresearch settings. From these projects, we report on common implementation barriers and facilitators. We then mapped these observations and strategies on to the phases and processes described in the Exploration, Preparation, Implementation, and Sustainment framework. Results The first implementation project used key stakeholders’ perspectives to develop a toolkit to implement Better Exercise Adherence after Treatment for Cancer, a self-managed intervention led by fitness professionals. The second project adapted a physical activity behavior change intervention (Active Living after Cancer) for use in the broader community. The third project adapted an in-person exercise intervention in a community setting (Physical Activity and Lymphedema) into an outpatient rehabilitation setting, including home-based intervention elements (Strength after Breast Cancer). We retrospectively collated and operationalized the implementation strategies based on the Experts Recommending Implementation Change study. The most common implementation barriers were related to funding, organizational capacity and training, relationship building, patient referral, and engagement with patients. Conclusions These implementation strategies provide initial starting points for the implementation of exercise oncology EBIs in clinical and community settings while also serving as examples for future implementation research to advance the translation of exercise oncology evidence.

An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology

“…Implementation of this triage and referral process was accomplished using well-documented approaches suggested by a recent review of exercise oncology implementation [ 12 ] and followed the EPIS framework [ 11 ]. Buy-in from clinical leadership, including physicians and nurses, was crucial, as was informing the staff, adaptability with regard to fitting into the clinical flow, and ensuring that all medical assistant staff were comfortable with the new processes before starting.…”

“…Goals of the QI initiative were to evaluate whether integrating a rehabilitation navigator and applying the EXCEEDS tool would be acceptable and feasible from the perspective of patients and clinical staff, as well as to assess the extent to which this approach would improve the proportion of patients referred to appropriate exercise or rehabilitation programming. The project was guided by the EPIS framework [ 11 ] (Exploration, Preparation, Implementation, and Sustainment) and prior efforts to map exercise oncology implementation strategies onto a compendium of implementation strategies [ 12 ].…”

“Now is the time for institutions to be investing in growing exercise programs as part of standard of care”: a multiple case study examining the implementation of exercise oncology interventions

“…This figure is consistent with other implementation research that suggests organisations typically employ numerous strategies [ 70 – 73 ]. To our knowledge, of studies that use the ERIC taxonomy to document implementation strategies in exercise EBI and cancer, many report fewer than ten strategies [ 42 , 74 ], with only one other study conducting comprehensive mapping [ 34 ]. Our process to identify strategies and then apply an inductive approach to develop the explanatory pathways helps address the identified gap between the number of strategies prospectively included in implementation trials and the actual number used when retrospectively identified [ 75 ].…”

Advocacy in Cancer Rehabilitation—A Beginner’s Guide to Effecting Change

“…It recommends research advancing cancer rehabilitation and exercise oncology must shift focus to good health services outcomes, cost-benefit analyses, and dissemination and implementation science 12 from merely effective interventions to establish a new standard of care. Efforts are needed to identify specific strategies that would result in more robust implementation 29 optimizing triage, workflow, and referral of cancer patients. 30,31…”