The development of a theory and evidence-based intervention to aid implementation of exercise into the prostate cancer care pathway with a focus on healthcare professional behaviour, the STAMINA trial

Abstract

Background Twice-weekly supervised aerobic and resistance exercise for 12 weeks reduces fatigue and improves quality of life in men on Androgen Deprivation Therapy for prostate cancer. Despite the National Institute for Health and Care Excellence (NICE) proposing this as standard of care, it does not routinely take place in practice. Healthcare professionals are in a prime position to deliver and integrate these recommendations. A change in the behaviour of clinical teams is therefore required. In this paper, we describe the development of a training package for healthcare professionals using theory and evidence to promote delivery of such recommendations as standard care. Methods The intervention development process was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. Target behaviours were identified from the literature and thirty-five prostate cancer care healthcare professionals (including oncologists, consultant urologists, clinical nurse specialists, physiotherapists, general practitioners and commissioners) were interviewed to understand influences on these behaviours. The Theoretical Domains Framework was used to identify theoretical constructs for change. Behaviour change techniques were selected based on theory and evidence and were translated into intervention content. The intervention was refined with the input of stakeholders including healthcare professionals, patients, and exercise professionals in the form of rehearsal deliveries, focus groups and a workshop. Results Seven modifiable healthcare professional target behaviours were identified to support the delivery of the NICE recommendations including identifying eligible patients suitable for exercise, recommending exercise, providing information, exercise referral, providing support and interpret and feedback on progress. Ten domains from the Theoretical Domain’s Framework were identified as necessary for change, including improving knowledge and skills, addressing beliefs about consequences, and targeting social influences. These were targeted through twenty-two behaviour change techniques delivered in a half-day, interactive training package. Based on initial feedback from stakeholders, the intervention was refined in preparation for evaluation. Conclusions We designed an intervention based on theory, evidence, and stakeholder feedback to promote and support the delivery of NICE recommendations. Future work will aim to test this training package in a multi-centre randomised trial. If proven effective, the development and training package will provide a template for replication in other clinical populations, where exercise has proven efficacy but is insufficiently implemented.

Embedding supervised exercise training for men on androgen deprivation therapy into standard prostate cancer care: a feasibility and acceptability study (the STAMINA trial)

“…Eligible HCPs and ETs received behaviourally informed, face-to-face, practical skill-based training to: (1) improve knowledge (2) increase confidence, (3) change beliefs, (4) establish social norms, (5) develop behaviour change skills and (6) change beliefs of their perceived role to support patient exercise behaviour 20 , 21 . HCP training was delivered within 7 days prior to the NHS sites recruitment start date and lasted a duration of half a day.…”

Supporting doctors' well‐being and resilience during COVID‐19: A framework for rapid and rigorous intervention development

“…Therefore, the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Behaviour Change Wheel (BCW) (Susan Michie et al, 2011), supplemented by the Theoretical Domains Framework (TDF) (Cane et al, 2012;Michie et al, 2005), were selected as appropriate underpinning theoretical frameworks for intervention development. These models are advantageous as they are evidencebased, have been usefully applied in multiple settings (Barker et al, 2016;Jatau et al, 2019;McGowan et al, 2020;Mosavianpour et al, 2016;Nickbakht et al, 2020;Timlin et al, 2020;Turner et al, 2021) and can be interpreted and applied relatively easily (Cane et al, 2012;Michie et al, 2005;Susan Michie et al, 2011).…”

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