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Paulo CM, Ali AA, Schmeusser BN, Midenberg E, Helman TA, Diller ML, Pisters MF, Ogan K, Master VA. Barriers and facilitators to physical activity prehabilitation in patients with kidney cancer. Eur J Oncol Nurs 2023; 65:102333. [PMID: 37295278 DOI: 10.1016/j.ejon.2023.102333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Timely and effective physical activity (PA) prehabilitation is an evidence-based approach for improving a patient's health status preoperatively. Identifying barriers and facilitators to PA prehabilitation can help inform best practices for exercise prehabilitation program implementation. We explore the barriers and facilitators to PA prehabilitation in patients undergoing nephrectomy. METHODS A qualitative exploratory study was conducted by interviewing 20 patients scheduled for nephrectomy. Interviewees were selected via convenience sampling strategy. The interviews were semi-structured and discussed experienced and perceived barriers/facilitators to PA prehabilitation. Interview transcripts were imported to Nvivo 12 for coding and semantic content analysis. A codebook was independently created and collectively validated. Themes of barriers and facilitators were identified and summarized in descriptive findings based on frequency of themes. RESULTS Five relevant themes of barriers to PA prehabilitation emerged: 1) mental factors, 2) personal responsibilities, 3) physical capacity, 4) health conditions, and 5) lack of exercise facilities. Contrarily, facilitators potentially contributing to PA prehabilitation adherence in kidney cancer included 1) holistic health, 2) social and professional support, 3) acknowledgment of health benefits, 4) exercise type and guidance, and 5) Communication channels. CONCLUSION AND KEY FINDINGS Kidney cancer patient's adherence to physical activity prehabilitation is influenced by multiple biopsychosocial barriers and facilitators. Hence, adherence to physical activity prehabilitation requires timely adaptation of health beliefs and behavior embedded in the reported barriers and facilitators. For this reason, prehabilitation strategies should strive to be patient-centered and include health behavioral change theories as underlying frameworks for sustaining patient engagement and self-efficacy.
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Affiliation(s)
- Cristiany M Paulo
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Adil A Ali
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Benjamin N Schmeusser
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric Midenberg
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Talia A Helman
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Maggie L Diller
- Department of Surgery of Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA
| | - Martijn F Pisters
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Kenneth Ogan
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Viraj A Master
- Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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Jensen BT, Thomsen T, Mohamed N, Paterson C, Goltz H, Retinger NL, Witt VR, Lauridsen SV. Efficacy of pre and rehabilitation in radical cystectomy on health related quality of life and physical function: A systematic review. Asia Pac J Oncol Nurs 2022; 9:100046. [PMID: 35662875 PMCID: PMC9160473 DOI: 10.1016/j.apjon.2022.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 01/01/2023] Open
Abstract
Objective The efficacy of prehabilitation or rehabilitation interventions on radical cystectomy (RC) patient reported outcomes (PROs), and patient centered outcome has not yet been thoroughly explored in prior reviews, therefore the aim of this review is to evaluate the efficacy of a single or multi-modal prehabilitation or/and postoperative rehabilitation interventions compared to standard treatment on postoperative complications after RC. Methods We performed a three-step search strategy in PubMed, Cinahl, Embase, Cochrane Library, and Web of Science. We used Covidence for the screening of articles, risk of bias assessment, and data-extraction. GRADE was used to assess the risk of bias in outcomes across studies. Where meta-analysis was possible, we used the random effect method due to substantial heterogeneity. The remaining outcomes were summarized narratively. Results We identified fourteen studies addressing one of the outcomes. None of the studies provided evidence to support that prehabilitation and/or rehabilitation interventions can improve global health related quality of life (HRQoL) in RC surgery or can reduce postoperative complications significantly. However, preoperative and postoperative education in stoma care can significantly improve self-efficacy and we found significant added benefits of sexual counseling to intracavernous injections compared to injection therapy alone. Likewise, an intensive smoking and alcohol cessation intervention demonstrated a significant effect on quit rates. Physical exercise is feasible and improves physical functioning although it does not reduce the postoperative complications. Conclusions Currently, no evidence of efficacy of prehabilitation and/or rehabilitation interventions to improve the overall HRQoL or postoperative complications after RC exists. We found evidence that education in stoma care improved self-efficacy significantly. Adequately powered randomized controlled trials (RCTs) are needed to generate high-quality evidence in this field.
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Affiliation(s)
| | - Thordis Thomsen
- Department of Anesthesia, Copenhagen University Hospital, Herlev, Denmark
| | - Nihal Mohamed
- Mount Sinai, Ichan Scool of Medicine, Department of Urology, USA
| | | | | | | | | | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark
- WHO-CC Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Denmark
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W AC, GJ N, T M, A A, A T, AL W, A R, S UL, J U, D M, R I, MJA P, K P. The impact of socio-economic deprivation on recovery following robotic assisted radical cystectomy. Urologia 2022; 90:136-140. [PMID: 35673803 DOI: 10.1177/03915603221100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Despite enhanced recovery programmes, length of stay is variable following robotic assisted radical cystectomy (RARC). The aim of this study was to assess the impact socioeconomic deprivation on recovery following RARC. Methods: The prospectively maintained RARC databases at two tertiary referral hospitals were reviewed from 2015 to 2017. Demographic, histological, and outcome data including length of stay (LOS), operation time and blood loss were recorded. The Index of Multiple Deprivation, was chosen as a deprivation index as this is used by the UK government to direct funding and resources to regions, towns and postal codes by assessing a number of indicators. Results: During the study period, 340 consecutive patients underwent RARC. Deprivation deciles were significantly higher in site 1 patients (7.9 in site 1 vs 6.6 in site 2, p < 0.001) implying that these patients are more likely to have higher incomes, levels of education and improved living environments. The mean operating time was longer in the site 1 cohort (397 vs 366 min, p > 0.001) with a reduced mean blood loss volume (252 and 484 mL, p < 0.001). There was a significant difference in mean LOS (6.2 days in site 1 vs 10.6 days in site 2, p < 0.001). On multivariable analysis, a higher deprivation decile did not predict LOS (OR = 1, 95% CI = 0.9–1.1, p = 0.407). Sex and operation site were however significantly associated with LOS (p = 0.006 and <0.001). Conclusion: Recovery following RARC was independent of socioeconomic status when comparing two hospitals with diverse catchment areas in the UK.
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Affiliation(s)
- Abou Chedid W
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Nason GJ
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Mahesan T
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Ashton A
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Tay A
- Department of Urology, St George’s Hospital, London, UK
| | - Walsh AL
- Department of Urology, St George’s Hospital, London, UK
| | - Roodhouse A
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Uribe-Lewis S
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Uribe J
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Moschonas D
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Issa R
- Department of Urology, St George’s Hospital, London, UK
| | - Perry MJA
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Patil K
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
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Joensen UN, Maibom SL, Poulsen AM. Surgical Management of Muscle Invasive Bladder Cancer: A Review of Current Recommendations. Semin Oncol Nurs 2021; 37:151104. [PMID: 33541734 DOI: 10.1016/j.soncn.2020.151104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To provide a narrative overview of contemporary surgical management of muscle-invasive bladder cancer with focus on radical cystectomy and urinary tract reconstruction. DATA SOURCES International guidelines and a search for articles in PubMed, Medline, and Cochrane Database for single and collaborative studies on surgical management of muscle-invasive bladder cancer. CONCLUSION Patients diagnosed with muscle invasive bladder cancer often have complex treatment and care needs. For those who undergo radical cystectomy as the curative treatment, there is a considerable risk of general complications after major surgery and short- and long-term complications specific to reconstruction of the urinary tract after radical cystectomy. Contemporary care focuses on perioperative optimization to lower rates of major complications, enhanced recovery protocols, and focus on rehabilitation and cancer survivorship. IMPLICATIONS FOR NURSING PRACTICE Nurses are integral members of the multidisciplinary team around patients undergoing surgery for muscle-invasive bladder cancer, and are in a position to coordinate pathways for these patients who often have complex care needs because of preexisting comorbidity and limited personal resources that impede recovery after major surgery and cancer survivorship.
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Affiliation(s)
- Ulla Nordström Joensen
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sophia Liff Maibom
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark
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Collaboration Between Oncology Social Workers and Nurses: A Patient-Centered Interdisciplinary Model of Bladder Cancer Care. Semin Oncol Nurs 2021; 37:151114. [PMID: 33431236 DOI: 10.1016/j.soncn.2020.151114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We propose a bladder cancer patient-centered, interdisciplinary collaboration model of care adapted from an earlier model by Black, Dornan, and Allegrante (1986). The Bladder Patient-Centered Interdisciplinary Team (BPIT) model provides a conceptual foundation for assembling interdisciplinary teams and emphasizes the patient as an active participant in treatment and member of the care team, along with oncology nurses, wound ostomy and continence nurses, and oncology social workers. DATA SOURCES This model integrates scopes of practice and practice standards from nursing and social work professional organizations, findings from peer-reviewed articles, and expert clinical opinion in conceptualizing interdisciplinary bladder cancer care. CONCLUSION BPIT is not meant to be an exhaustive or proscriptive catalog of roles and responsibilities. Future research is needed in this area to further refine and delineate the oncology social worker and nursing scopes of practice and standards for collaborative teamwork. IMPLICATIONS FOR NURSING PRACTICE The unmet supportive care needs of patients with bladder cancer across all phases of the cancer continuum are well documented. Oncology and wound ostomy and continence nurses are of critical importance to holistically addressing these needs and enhancing the health-related quality of life. The BPIT model provides a broad overview of the discipline-specific and interdisciplinary team-specific roles and responsibilities for bladder cancer care.
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Jensen BT. Organization Factors in the ERAS Bladder Cancer Pathway: The Multifarious Role of the ERAS Nurse, Why and What Is Important? Semin Oncol Nurs 2021; 37:151106. [PMID: 33431234 DOI: 10.1016/j.soncn.2020.151106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This paper provides an overview of the multifarious role of nursing in enhanced recovery after surgery (ERAS) in advanced bladder cancer surgery with procedure-specific recommendations in radical cystectomy pathways. DATA SOURCES Electronic databases including PubMed and CINAHL. CONCLUSION The growing evidence of preoperative, perioperative, and postoperative interventions and the concept of reacting proactively in ERAS, has led to the paradigm shift in the surgical pathway with establishment of nurse-led multi-professional prehabilitation academies. Moreover, although most patients will recover in real-life at home, there is a need for a change in postoperative and discharge management. Thus, a highly skilled discharge nurse is required to secure a comprehensive, safe discharge plan adjusted to the patient's needs in close cooperation with the primary care setting, family, and survivorship clinic if needed. Limited efforts have been made to evaluate rational principles and goals for rehabilitation after radical cystectomy; an important issue with major patient and perhaps socioeconomic consequences, wherein the ERAS nurse may take the future lead. IMPLICATION FOR NURSING PRACTICE It has become a governmental demand in many countries to involve the patient and family in treatment decisions and care by using shared decision tools, and to educate and inform each family in concordance with the patient's needs and preferences, and the health care systems must react accordingly. However, to provide person-centeredness care within advanced surgical pathways, there remains a need for thought-leaders, strategic planners, managers, and decision-makers to anchor the process of change and stop "we do it anyway" arguments to defend organizational cultures that are not conducing the evidence-recommend practice.
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Affiliation(s)
- Bente Thoft Jensen
- Department of Urology & Urological Research Unit, Aarhus University Hospital (DK), Denmark.
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