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Renouf T, Barlow R, Patel T. Barriers and facilitators to giving prehabilitation advice by clinical nurse specialists and advanced nurse practitioners in oncology patients. Support Care Cancer 2024; 32:158. [PMID: 38358590 DOI: 10.1007/s00520-023-08273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE This is the second article in this series on the knowledge, attitudes and beliefs of clinical nurse specialists (CNSs) and ANPs (advanced nurse practitioners) regarding prehabilitation advice in oncology patients, exploring the barriers and facilitators to giving prehabilitation advice by CNSs and ANPs in oncology patients. METHODS A Cross-sectional online questionnaire opens for 3 months to establish the knowledge, attitudes and beliefs of ANPs and CNSs to prehabilitation disseminated through professional organisations and social media. RESULTS The questionnaire gained (n = 415) responses. Prehabilitation advice was routinely given by 89% (n = 371) of respondents. Many (60%) identified a lack of guidance and referral processes as a barrier to giving prehabilitation advice; this corresponded between respondents' confidence to give prehabilitation advice and subsequent referrals (< 0.001). Other factors included time (61%), a lack of patient interest (44%) and limited relevance to patients (35%). CONCLUSION The implementation of standardised nurse prehabilitation advice resources would enable CNSs and ANPs to provide personalised prehabilitation advice in their consultations.
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Affiliation(s)
- Tessa Renouf
- The Royal Marsden NHS Foundation Trust, London, UK.
| | | | - Tunia Patel
- Cardiff and Wales University Health Board, Wales, UK
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2
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Koutoukidis DA, Jebb SA, Foster C, Wheatstone P, Horne A, Hill TM, Taylor A, Realpe A, Achana F, Buczacki SJA. CARE: Protocol of a randomised trial evaluating the feasibility of preoperative intentional weight loss to support postoperative recovery in patients with excess weight and colorectal cancer. Colorectal Dis 2023; 25:1910-1920. [PMID: 37525408 DOI: 10.1111/codi.16687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/02/2023]
Abstract
AIM Excess weight increases the risk of morbidity following colorectal cancer surgery. Weight loss may improve morbidity, but it is uncertain whether patients can follow an intensive weight loss intervention while waiting for surgery and there are concerns about muscle mass loss. The aim of this trial is to assess the feasibility of intentional weight loss in this setting and determine progression to a definitive trial. METHODS CARE is a prospectively registered, multicentre, feasibility, parallel, randomised controlled trial with embedded evaluation and optimisation of the recruitment process. Participants with excess weight awaiting curative colorectal resection for cancer are randomised 1:1 to care as usual or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian. Progression criteria will be based on the recruitment, engagement, adherence, and retention rates. Data will be collected on the 30-day postoperative morbidity, the typical primary outcome of prehabilitation trials. Secondary outcomes will include, among others, length of hospital stay, health-related quality of life, and body composition. Qualitative interviews will be used to understand patients' experiences of and attitudes towards trial participation and intervention engagement and adherence. CONCLUSION CARE will evaluate the feasibility of intensive intentional weight loss as prehabilitation before colorectal cancer surgery. The results will determine the planning of a definitive trial.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC+ in Health Sciences, University of Southampton, Southampton, UK
| | | | - Alison Horne
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - T Martyn Hill
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Amy Taylor
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Felix Achana
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon J A Buczacki
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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JM S, K P, S W, H C, AS A, H C, J C, RJ C, J G, J H, RJQ M, C W. The experiences and perceptions of female breast cancer patients regarding weight management during and after treatment for oestrogen-receptor positive disease: a qualitative study. BMC Cancer 2022; 22:1189. [DOI: 10.1186/s12885-022-10238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Weight gain is commonly observed during and after breast cancer treatment and is associated with poorer survival outcomes, notably in women with oestrogen-receptor positive disease. The aim of this qualitative study was to investigate the experiences and perceptions of oestrogen-receptor positive (ER +) female breast cancer patients (BCPs) regarding weight management behaviours during and after treatment. Secondly, to gain insight into the experiences of healthcare professionals (HCPs) regarding the provision of weight management advice to patients undergoing treatment.
Methods
Four focus groups involving 16 BCPs having a median (range) age of 51 (35–70 y) and three focus groups involving 21 HCPs aged 46 (29–62) were held at a university campus, local cancer support centre or clinical site. Data were analysed using Framework analysis.
Results
Four overarching themes (and 10 subthemes) were identified: (1) Treatment; (2) Support for lifestyle behaviour change; (3) Information availability for BCPs; (4) Knowledge of current evidence amongst HCPs. The physical and psychological consequences of treatment influenced motivation for weight management amongst BCPs. Social support for health promoting behaviours was viewed as important but was conflicting, requiring context-specific considerations. BCPs said they would have welcomed access to credible information (guided by HCPs) about the potential detrimental health effects of excess body weight and weight gain, together with advice on weight management via healthy eating and physical activity. HCPs felt that they had insufficient knowledge of public health dietary and physical activity recommendations or evidence-based interventions to confidently offer such advice. HCPs expressed concern that raising weight management issues would exacerbate distress or invoke feelings of guilt amongst BCPs, and cited time pressures on patient consultations as additional barriers to providing weight management support.
Conclusion
The study yielded novel insights into factors influencing weight management behaviours amongst overweight ER + BCPs. The results suggest that evidence-based information and support, which addresses key physical and psychological challenges to physical activity and dietary behaviours, offers the best route to sustainable weight management in this population.
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Joseph R, Hart NH, Bradford N, Agbejule OA, Koczwara B, Chan A, Wallen MP, Chan RJ. Diet and exercise advice and referrals for cancer survivors: an integrative review of medical and nursing perspectives. Support Care Cancer 2022; 30:8429-8439. [PMID: 35616734 PMCID: PMC9512858 DOI: 10.1007/s00520-022-07152-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022]
Abstract
Purpose To examine the perspectives of medical and nursing health professionals concerning their roles and responsibilities in providing dietary and exercise advice to cancer survivors, and referrals to allied health professionals. Methods An integrative review. PubMed, CINAHL, PsycINFO, Embase, Web of Science databases, and bibliographies of relevant studies were searched from December 2011 to June 2021. All studies were eligible for inclusion. The Mixed-Methods Appraisal Tool (MMAT) was used to critically appraise included studies. Data were extracted and synthesised regarding the perspectives of medical and nursing health professionals on their roles, responsibilities, barriers, and facilitators. Results Twenty-one studies involving 3401 medical and nursing health professionals and 264 cancer survivors of diverse cancer types were included. Ten quantitative, nine qualitative, and two mixed-methods studies were eligible. All included studies met at least 80% of the quality criteria in the MMAT. Major findings include the following: (1) medical and nursing health professionals were unclear on their roles in providing dietary and exercise advice to cancer survivors but agreed they play a key role in referrals to dietitians and exercise professionals; (2) most cancer survivors valued the involvement of their general practitioner when receiving dietary and exercise advice. Conclusion Although medical and nursing health professionals understand that referrals to allied health professionals form part of their role, there is a lack of clarity regarding their roles to provide dietary and exercise advice to cancer survivors. Future studies should address barriers and facilitators of dietary and exercise advice and referral by medical and nursing health professionals. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07152-w.
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Affiliation(s)
- Ria Joseph
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Nicolas H Hart
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.,Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia.,Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, USA
| | - Matthew P Wallen
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, Australia
| | - Raymond J Chan
- Caring Futures Institute, College and Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
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Comparing Outcomes of a Digital Commercial Weight Loss Program in Adult Cancer Survivors and Matched Controls with Overweight or Obesity: Retrospective Analysis. Nutrients 2021; 13:nu13092908. [PMID: 34578787 PMCID: PMC8470305 DOI: 10.3390/nu13092908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Maintaining a healthy weight is beneficial for cancer survivors. However, weight loss program effectiveness studies have primarily been in highly controlled settings. This is a retrospective study exploring real-world outcomes (weight loss and program engagement) after use of a digital commercial weight loss program (Noom) in cancer survivors and matched controls. All participants had voluntarily self-enrolled in Noom. Weight and engagement data were extracted from the program. Cancer-related quality of life was secondarily assessed in a one-time cross-sectional survey for survivors. Controls were a sample of Noom users with overweight/obesity who had no history of cancer but 0–1 chronic conditions. Primary outcomes were weight change at 16 weeks and program engagement over 16 weeks. Engagement included frequency of weight, food, and physical activity logging, as well as number of coach messages. Multiple regression controlling for baseline age, gender, engagement, and BMI showed that survivors lost less weight than controls (B = −2.40, s.e. = 0.97, p = 0.01). Survivors also weighed in less (survivors: 5.4 [2.3]; controls: 5.7 [2.1], p = 0.01) and exercised less (survivors: 1.8 [3.2]; controls: 3.2 [4.1], p < 0.001) than controls. However, survivors sent more coach messages (survivors: 2.1 [2.4]; controls: 1.7 [2.0], p < 0.001). Despite controls losing more weight than cancer survivors (−7.0 kg vs. −5.3 kg), survivors lost significant weight in 4 months (M = −6.2%). Cancer survivors can have success on digital commercial programs available outside of a clinical trial. However, they may require additional support to engage in weight management behaviors.
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Semper K, Hernon J, Wynter T, Baker K, Saxton JM. Physical activity advice in the UK bowel cancer screening setting: qualitative healthcare professional perspectives. Health Promot Int 2021; 37:6307147. [PMID: 34151969 DOI: 10.1093/heapro/daab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Providing physical activity advice in the bowel cancer screening setting could help to reduce the risk of cancer and cardiometabolic disease in older adults. This study investigated the views of healthcare professionals (HCPs) regarding the provision of physical activity advice as part of the UK Bowel Cancer Screening Programme. A purposive sample of HCPs (aged 22-63 years, with 1-26 years of experience) from four bowel cancer screening disciplines (four endoscopists, four colorectal surgeons, four staff nurses and four specialist screening practitioners) were recruited from a large National Health Service gastroenterology unit. Data collection used individual interviews and focus groups, with topics being guided by an a priori topic guide. All interviews and focus groups were audio-recorded and transcribed verbatim. Three key themes, which contextualize the views and perceptions of HCPs recruited to the study, emerged from the framework analysis: (i) appraisal of the concept; (ii) perceived barriers to implementation; (iii) steps to implementation. While the general concept was viewed positively, there were differences of opinion and a range of perceived barriers were revealed. Ideas for effective implementation were also presented, taking into consideration the need for time efficiencies and importance of optimizing effectiveness. This qualitative study provided important insights into the perceptions of HCPs regarding the provision of physical activity advice in the bowel cancer screening setting, and yielded novel ideas for effective implementation.
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Affiliation(s)
- Kelly Semper
- Norfolk County Council, Tydd St Mary, Lincolnshire, UK
| | - James Hernon
- Department of General Surgery, Norfolk and Norwich University Hospital Foundation Trust, Norfolk, UK
| | - Trevor Wynter
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - John M Saxton
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
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Anderson AS, Martin RM, Renehan AG, Cade J, Copson ER, Cross AJ, Grimmett C, Keaver L, King A, Riboli E, Shaw C, Saxton JM. Cancer survivorship, excess body fatness and weight-loss intervention-where are we in 2020? Br J Cancer 2021; 124:1057-1065. [PMID: 33235316 PMCID: PMC7961062 DOI: 10.1038/s41416-020-01155-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023] Open
Abstract
Earlier diagnosis and more effective treatments mean that the estimated number of cancer survivors in the United Kingdom is expected to reach 4 million by 2030. However, there is an increasing realisation that excess body fatness (EBF) is likely to influence the quality of cancer survivorship and disease-free survival. For decades, the discussion of weight management in patients with cancer has been dominated by concerns about unintentional weight loss, low body weight and interventions to increase weight, often re-enforced by the existence of the obesity paradox, which indicates that high body weight is associated with survival benefits for some types of cancer. However, observational evidence provides strong grounds for testing the hypothesis that interventions for promoting intentional loss of body fat and maintaining skeletal muscle in overweight and obese cancer survivors would bring important health benefits in terms of survival outcomes and long-term impact on treatment-related side effects. In this paper, we outline the need for studies to improve our understanding of the health benefits of weight-loss interventions, such as hypocaloric healthy-eating plans combined with physical activity. In particular, complex intervention trials that are pragmatically designed are urgently needed to develop effective, clinically practical, evidence-based strategies for reducing EBF and optimising body composition in people living with and beyond common cancers.
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Affiliation(s)
- Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Division of Population Health & Genomics, University of Dundee Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Richard M Martin
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, G11, Stead House, University of Leeds, Leeds, LS2 9JT, UK
| | - Ellen R Copson
- Wessex Genomic Medicine Centre, Cancer Sciences Academic Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Laura Keaver
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, F91 YW50, Ireland
| | - Angela King
- NIHR Cancer and Nutrition Collaboration, Level E and Pathology Block (mailpoint 123), Southampton General Hospital, Tremona Road, Southampton, SO 16 6YD, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Clare Shaw
- Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - John M Saxton
- Department of Sport, Exercise & Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK
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Robinson A, Husband AK, Slight RD, Slight SP. Digital technology to support lifestyle and health behaviour changes in surgical patients: systematic review. BJS Open 2020; 5:6054048. [PMID: 33688953 PMCID: PMC7944850 DOI: 10.1093/bjsopen/zraa009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 06/10/2020] [Accepted: 08/23/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digital technologies (such as smartphone applications, activity trackers, and e-learning platforms) have supported patients with long-term conditions to change their lifestyle health behaviours. The aim of this study was to examine the effectiveness of digital technologies in supporting patients undergoing elective surgery to change their health behaviours. METHODS A systematic review was conducted of articles reporting a digital intervention supporting behaviour change in adult patients who underwent elective bariatric, oncological or orthopaedic surgery. MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Scopus were searched from inception to March 2019 for quantitative intervention studies with a specific focus on physical activity, dietary intake, and weight loss in patients before and after surgery (PROSPERO: CRD42019127972). The Joanna Briggs Institute critical appraisal checklist was used to assess study quality. RESULTS Of 3021 citations screened, 17 studies were included comprising 4923 surgical patients; these included experimental (pre-post design, feasibility studies, and RCTs) and observational studies. Three factors were identified as effective for supporting health behaviour change in elective surgical populations: digital technology delivery, implementation, and theoretical underpinning. Six of eight studies that referred to behaviour change theories observed significant improvements in health behaviour relating to reduced weight regain, and improved lifestyle choices for physical activity and diet. Meta-analysis was not possible because of heterogeneous outcome measures. CONCLUSION Digital technologies may effectively support behavioural change in patients undergoing elective surgery.
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Affiliation(s)
- A Robinson
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - A K Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - R D Slight
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Bryant J, Turon H, Mansfield E, Cameron E, Dodd N. Discussions About Lifestyle Risk Factors Following a Cancer Diagnosis: Findings from a Sample of Australian Cancer Outpatients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1170-1176. [PMID: 31317514 DOI: 10.1007/s13187-019-01575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Individuals with a previous cancer diagnosis are at risk of cancer recurrence. However, many cancer survivors do not adhere to lifestyle recommendations to reduce cancer risk. Little is known about the extent to which cancer patients are asked about lifestyle risk factors by healthcare providers following diagnosis. The aim of this study is to determine among Australian cancer survivors the (1) proportion asked about smoking, alcohol consumption, nutrition and physical activity; (2) total number of lifestyle risk factors asked about; and (3) factors associated with being asked about fewer risk factors. A cross-sectional survey was conducted with cancer patients attending outpatient clinics. Eligible patients completed a baseline survey and a second survey 4 weeks later. Data about demographic and disease characteristics, and whether participants had been asked about smoking, alcohol, physical activity and diet since being diagnosed with cancer, was collected. A total of 144 patients were included in the analyses. Following diagnosis, most had been asked about smoking (86%), alcohol consumption (85%), physical activity (80%) and diet (69%) by a healthcare provider. Sixty-one percent of participants reported being asked about all four risk factors; only 6% recalled being asked about none. After controlling for age, participants with a high school or lower education were more likely to be asked about fewer risk factors (OR 2.16; 95%CI 1.0 to 4.6; p = 0.04) compared with those with a trade, vocational or university-level education. Just over one-third of a sample of Australian cancer patients were not asked about all assessed lifestyle risk factors following their diagnosis of cancer. These findings suggest there is scope to improve identification of lifestyle risk factors among cancer survivors.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Heidi Turon
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Emilie Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Natalie Dodd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Anderson A, Barnett K, Bhagat M, Steele R. A qualitative evaluation of the impact of a training programme on colorectal cancer risk reduction for Specialist Screening Practitioners on health promotion, knowledge and practice. Eur J Cancer Care (Engl) 2020; 30:e13350. [PMID: 33119181 PMCID: PMC7900982 DOI: 10.1111/ecc.13350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/15/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Objective Colorectal cancer (CRC) is the fourth most common cancer in the UK. It is estimated that around 50% of the disease burden is caused by lifestyle factors. This paper evaluates the impact of a training programme for Specialist Screening Practitioners (SSPs) on knowledge of CRC risk reduction and subsequent health promotion activities. Method Attendees (n = 21) were invited to participate in semi‐structured qualitative telephone interviews developed in conjunction with programme organisers. An independent researcher undertook the interviews on the perceived impact of the training on knowledge about risk reduction, communicating health promotion messages and working practices. Results Ten interviews were conducted. The programme was perceived to be successful in increasing knowledge about CRC risk and methods to promote behavioural change. Participants questioned the suitability of the endoscopy setting to communicate health promotion messages given patient anxiety pre‐investigation and post‐investigation elation after negative results. Key barriers to health promotion activities were time, hesitancy over raising issues that could not be easily discussed and scepticism about the ability of older adults to change their lifestyle. Conclusions Training on CRC risk reduction increased knowledge and behaviour change skills among SSPs. Further work is needed to explore opportunities to optimise the screening environment for health promotion activities.
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Affiliation(s)
- Annie Anderson
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Karen Barnett
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Meena Bhagat
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Robert Steele
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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11
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Correlates of Physical Activity in Colorectal Cancer Patients Based on Health Promotion Model. Cancer Nurs 2020; 43:E264-E272. [PMID: 32813487 DOI: 10.1097/ncc.0000000000000725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing attention is being given to physical activity in colorectal cancer patients. Some studies have explored a few correlates of physical activity separately. A contemporary study based on the Health Promotion Model may systematically broaden the understanding of physical activity in colorectal cancer patients. OBJECTIVE To understand the status of physical activity in Chinese colorectal cancer patients and to explore the correlated factors. METHODS A total of 168 adults with colorectal cancer were recruited at 3 tertiary hospitals in China. Participant data were collected on demographics, physical activity, biological factors, anxiety and depression, benefits/barriers to physical activity, self-efficacy, and social support. SAS 8.2 was used for statistical analysis, including descriptive analysis, correlation analysis, single factor analysis, and multiple stepwise regression analysis. RESULTS Only 25.60% of colorectal cancer survivors reached the requirements of the Colorectal Cancer Survivorship Care Guidelines. Employment states, number of complications, fatigue, body image, depression, perception of benefits/barriers, and self-efficacy were closely correlated with physical activity in Chinese colorectal cancer patients. CONCLUSIONS The physical activity status of patients with colorectal cancer is not optimal. The correlated factors that nurses can take measures to improve are fatigue, body image, depression, perception of benefits/barriers, and self-efficacy, which may improve physical activity in colorectal cancer patients in China. Additional research is needed to determine if improving factors correlated with physical activity will assist with directly increasing physical activity. IMPLICATIONS FOR PRACTICE Nurses should evaluate physical activity of colorectal cancer patients timely and play an active role in health promotion programs to improve colorectal cancer patients' physical activity.
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12
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Robinson A, Husband AK, Slight RD, Slight SP. Digital Support for Patients Undergoing Bariatric Surgery: Narrative Review of the Roles and Challenges of Online Forums. JMIR Perioper Med 2020; 3:e17230. [PMID: 33393926 PMCID: PMC7709839 DOI: 10.2196/17230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background The internet has become an important medium within health care, giving patients the opportunity to search for information, guidance, and support to manage their health and well-being needs. Online forums and internet-based platforms appear to have changed the way many patients undergoing bariatric surgery view and engage with their health, before and after weight loss surgery. Given that significant health improvements result from sustained weight loss, ensuring patient adherence to recommended preoperative and postoperative guidance is critical for bariatric surgery success. In a patient cohort with high information needs preoperatively, and notoriously high attrition rates postoperatively, online forums may present an underutilized method of support. Objective The aim of this study was to conduct a narrative review focusing on the developing roles that online forums can play for patients with bariatric conditions preoperatively and postoperatively. Methods A literature search was conducted in October-November 2019 across 5 electronic databases: Scopus, EMBASE, PsycINFO, CINAHL, and MEDLINE. Qualitative or mixed methods studies were included if they evaluated patients undergoing bariatric surgery (or bariatric surgery health care professionals) engaging with, using, or analyzing online discussion forums or social media platforms. Using thematic analysis, themes were developed from coding patterns within the data to identify the roles and challenges of online forums for patients undergoing bariatric surgery. Results A total of 8 studies were included in this review, with 5 themes emerging around (1) managing expectations of a new life; (2) decision making and signposting; (3) supporting information seeking; (4) facilitating connectedness: peer-to-peer social and emotional support; and (5) enabling accessibility and connectivity with health care professionals. Conclusions Online forums could offer one solution to improving postoperative success by supporting and motivating patients. Future research should consider how best to design and moderate online forums for maximal effectiveness and the sharing of accurate information. The surgical multidisciplinary team may consider recommendations of online peer-support networks to complement care for patients throughout their surgical journey.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Andrew K Husband
- School of Pharmacy, Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Robert D Slight
- Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Sarah P Slight
- School of Pharmacy, Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
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13
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Romero-Elías M, Beltrán-Carrillo VJ, González-Cutre D, Jiménez-Loaisa A. Barriers to physical activity participation in colorectal cancer patients during chemotherapy treatment: A qualitative study. Eur J Oncol Nurs 2020; 46:101769. [PMID: 32506009 DOI: 10.1016/j.ejon.2020.101769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To explore the barriers that colorectal cancer patients (stage II and III) perceive to participate in physical activity (PA) when involved in adjuvant chemotherapy. Views of relatives and physicians concerning this issue were also included. METHOD Qualitative data from ten patients, ten relatives, and ten health professionals were obtained through semi-structured interviews (n = 30). RESULTS Two main themes were identified after data analysis: (a) barriers to PA related to ostomy and adjuvant chemotherapy and (b) barriers related to perceived lack of support for PA. In regard to the first theme, participants reported difficulties associated with the ostomy, limitations of the intravenous chemotherapy device, fatigue and reduced physical fitness, and focusing on cancer and restructuring priorities. Concerning the perceived lack of support for PA, participants referred to their families' overprotection, the health professionals' lack of knowledge and time to prescribe PA, and the lack of PA services in health centres. CONCLUSIONS Further information from health professionals about the recommendations of PA and its benefits during adjuvant chemotherapy could palliate these PA barriers. The offer of specific PA programmes for these patients is also recommended.
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Affiliation(s)
- María Romero-Elías
- Department of Sport Sciences. Sport Research Centre. Miguel Hernández University of Elche, Spain.
| | | | - David González-Cutre
- Department of Sport Sciences. Sport Research Centre. Miguel Hernández University of Elche, Spain.
| | - Alejandro Jiménez-Loaisa
- Department of Sport Sciences. Sport Research Centre. Miguel Hernández University of Elche, Spain.
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14
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Sinclair JMA, Dutey-Magni PF, Anderson AS, Baird J, Barker ME, Cutress RI, Kaner EFS, McCann M, Priest CK, Copson ER. A Context-Specific Digital Alcohol Brief Intervention in Symptomatic Breast Clinics (Abreast of Health): Development and Usability Study. JMIR Res Protoc 2020; 9:e14580. [PMID: 32012091 PMCID: PMC7007589 DOI: 10.2196/14580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/25/2019] [Accepted: 09/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background Potentially modifiable risk factors account for approximately 23% of breast cancer cases. In the United Kingdom, alcohol consumption alone is held responsible for 8% to 10% of cases diagnosed every year. Symptomatic breast clinics focus on early detection and treatment, but they also offer scope for delivery of low-cost lifestyle interventions to encourage a cancer prevention culture within the cancer care system. Careful development work is required to effectively translate such interventions to novel settings. Objective The aim of this study was to develop a theory of change and delivery mechanism for a context-specific alcohol and lifestyle brief intervention aimed at women attending screening and symptomatic breast clinics. Methods A formative study combined evidence reviews, analysis of mixed method data, and user experience research to develop an intervention model, following the 6 Steps in Quality Intervention Development (6SQuID) framework. Results A Web app focused on improving awareness, encouraging self-monitoring, and reframing alcohol reduction as a positive choice to improve health was found to be acceptable to women. Accessing this in the clinic waiting area on a tablet computer was shown to be feasible. An important facilitator for change may be the heightened readiness to learn associated with a salient health visit (a teachable moment). Women may have increased motivation to change if they can develop a belief in their capability to monitor and, if necessary, reduce their alcohol consumption. Conclusions Using the 6SQuID framework supported the prototyping and maximized acceptability and feasibility of an alcohol brief intervention for women attending symptomatic breast clinics, regardless of their level of alcohol consumption.
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Affiliation(s)
- Julia M A Sinclair
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Peter F Dutey-Magni
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Division of Population Health & Genomics, University of Dundee Medical School, Dundee, United Kingdom
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,National Institute of Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mary E Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,National Institute of Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ramsey I Cutress
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Eileen F S Kaner
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Mark McCann
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Caspian K Priest
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ellen R Copson
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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15
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Patel A, Schofield G, Keogh J. Influences on health-care practitioners' promotion of physical activity to their patients with prostate cancer: a qualitative study. J Prim Health Care 2019; 10:31-38. [PMID: 30068449 DOI: 10.1071/hc17036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Physical activity is beneficial for the physical and psychological health of patients with prostate cancer (PCa). Health-care practitioners are ideally positioned to promote physical activity to their patients. AIM To identify factors that influenced health care practitioners to either promote or not promote physical activity to their patients with PCa. METHODS Individual interviews were conducted with 16 Auckland-based health-care practitioners, including specialists (oncologists and urologists), physiotherapists and complementary and alternative (acupuncturists) health-care practitioners. Data were analysed using an inductive thematic approach. RESULTS Treatment-related factors (ie counteracting side-effects of hormone suppression treatment), longer life expectancy and risk factors for other conditions appeared to influence the promotion of physical activity to patients. Time constraints of consultations and complex medical issues were barriers to the promotion of physical activity. CONCLUSIONS This study found that a variety of health-care practitioners are providing some degree of physical activity advice to their patients with PCa. Collaborative practice among health-care practitioners to verbally reinforce the benefits of physical activity, coupled with referral to experts in physical activity promotion/rehabilitation (such as physiotherapists), should be encouraged for best practice care.
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Affiliation(s)
- Asmita Patel
- School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Grant Schofield
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Justin Keogh
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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16
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Spring B, Stump T, Penedo F, Pfammatter AF, Robinson JK. Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change. Health Psychol 2019; 38:840-850. [PMID: 31436465 PMCID: PMC6709684 DOI: 10.1037/hea0000760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. METHOD We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. RESULTS Findings indicate that no entity in the health care system self-identifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. CONCLUSIONS To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Tammy Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | | | - June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine
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17
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Stump TK, Robinson JK, Yanez B, Penedo F, Ezeofor A, Kircher S, Spring B. Physicians' perspectives on medication adherence and health promotion among cancer survivors. Cancer 2019; 125:4319-4328. [PMID: 31448414 DOI: 10.1002/cncr.32410] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer survivors face an increased risk of cardiovascular events compared with the general population. Adopting a healthy lifestyle may reduce these risks, and guidelines encourage health-promotion counseling for cancer survivors, but the extent of physician adherence is unclear. METHODS This mixed-method study surveyed 91 physicians, including 30 primary care physicians (PCPs), 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists). Interviews also were conducted with 12 oncologists. RESULTS Most PCPs (90%) reported recommending health promotion (eg, weight loss, smoking cessation) to at least some cancer survivors, whereas few oncologists (26.7%) and specialists (9.7%) said they ever did so (P < .001). Although most physicians believed that at least 50% of cancer survivors would be adherent to medication regimens to prevent cancer recurrence, they also believed that, if patients were trying to lose weight, they would not remain medication-adherent. In interviews, oncologists expressed fear that providing health-promotion advice would distress or overwhelm patients. Additional health-promotion barriers identified by thematic analysis included: identifying cancer as oncologists' focal concern, time pressure, insufficient behavior change training, and care coordination challenges. Facilitators included perceiving a patient benefit and having health-promotion resources integrated into the cancer care system. CONCLUSIONS Physicians often do not have the time, expertise, or resources to address health promotion with cancer survivors. Research is needed to evaluate whether health-promotion efforts compromise medical regimen adherence, as physicians' responses suggest.
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Affiliation(s)
- Tammy K Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - June K Robinson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Betina Yanez
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Adaeze Ezeofor
- School of Medicine, Howard University, Washington, District of Columbia
| | - Sheetal Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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18
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van Veen MR, Mols F, Smeets L, Kampman E, Beijer S. Colorectal cancer survivors' beliefs on nutrition and cancer; correlates with nutritional information provision. Support Care Cancer 2019; 28:1255-1263. [PMID: 31227989 PMCID: PMC6989414 DOI: 10.1007/s00520-019-04934-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
Purpose To investigate CRC survivors’ beliefs on nutrition and cancer and the association with nutritional information provision by (kind and number) of health professionals and to inquire about foods that CRC survivors believed either had a positive or negative influence on their cancer. Methods A total of 326 CRC survivors of an ongoing prospective cohort study filled out questionnaires 1 month after surgery on whether they had received nutritional information from health professionals. Also, their beliefs that nutrition influences (1) feelings of well-being, (2) complaints after treatment, (3) recovery and (4) cancer recurrence were investigated. Prevalence ratios were calculated (using Cox proportional hazard regression analysis) to study associations between information provision and the four beliefs adjusted for age, gender and cancer stage. Results Sixty-two percent of respondents received information about nutrition from one or more health professionals. Most respondents who received information strongly believe nutrition influences feelings of well-being (59%) and recovery after cancer (62%). Compared with those who did not receive information, respondents who received information from three professionals showed the strongest beliefs on the influence of nutrition on complaints after treatment (PR 3.4; 95% CI 1.6–7.4), recovery after treatment (PR 2.0; 95% CI 1.2–3.3) and recurrence (PR 2.8; 95% CI 1.3–6.2). Conclusion Nutritional information provision by health professionals positively influences the beliefs of CRC survivors on the influence of nutrition on cancer outcomes: stronger beliefs occur when respondents received information from three health professionals.
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Affiliation(s)
- Merel R van Veen
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA, Wageningen, The Netherlands. .,Department of Research & Development Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - Floortje Mols
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Lian Smeets
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Sandra Beijer
- Department of Research & Development Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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19
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Anderson AS, Caswell S, Mowat C, Strachan JA, Steele RJC. Lifestyle in patients at increased risk of colorectal cancer. J Hum Nutr Diet 2019; 32:570-577. [DOI: 10.1111/jhn.12663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A. S. Anderson
- Centre for Research into Cancer Prevention and Screening Cancer Research Division Ninewells Hospital & Medical School Dundee UK
| | - S. Caswell
- Centre for Research into Cancer Prevention and Screening Cancer Research Division Ninewells Hospital & Medical School Dundee UK
| | - C. Mowat
- Department of Gastroenterology Ninewells Hospital Dundee UK
| | | | - R. J. C. Steele
- Centre for Research into Cancer Prevention and Screening Cancer Research Division Ninewells Hospital & Medical School Dundee UK
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20
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Karvinen KH, Balneaves L, Courneya KS, Perry B, Truant T, Vallance J. Evaluation of Online Learning Modules for Improving Physical Activity Counseling Skills, Practices, and Knowledge of Oncology Nurses. Oncol Nurs Forum 2018; 44:729-738. [PMID: 29052662 DOI: 10.1188/17.onf.729-738] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the effectiveness of online learning modules for improving physical activity counseling practices among oncology nurses.
. DESIGN Randomized, controlled trial.
. SETTING Online.
. SAMPLE 54 oncology nurses.
. METHODS Oncology nurses were randomly assigned to the learning modules group or control group. The learning modules group completed six online learning modules and quizzes focused on physical activity for cancer survivors, general physical activity principles, and motivational interviewing.
. MAIN RESEARCH VARIABLES Percentage of cancer survivors counseled, self-efficacy for physical activity counseling, knowledge of physical activity, and perceived barriers and benefits of physical activity counseling.
. FINDINGS Analyses of covariance revealed no significant difference between the learning modules and control groups in the percentage of cancer survivors that oncology nurses counseled. Significant differences were found in self-efficacy for physical activity counseling and perceived barriers to physical activity counseling at postintervention.
. CONCLUSIONS The online learning intervention tested in this study improved some parameters of physical activity counseling but did not increase the percentage of cancer survivors that oncology nurses counseled. Additional pilot work is needed to refine the intervention.
. IMPLICATIONS FOR NURSING This study suggests the potential utility of an evidence-based online learning strategy for oncology nurses that includes information on physical activity and its benefits in cancer survivorship. The findings offer a framework on how to implement physical activity counseling skills in oncology nursing practice.
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Affiliation(s)
| | | | - Kerry S Courneya
- Faculty of Physical Education, University of Alberta, Edmonton, Canada
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21
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Macleod M, Steele RJC, O'Carroll RE, Wells M, Campbell A, Sugden JA, Rodger J, Stead M, McKell J, Anderson AS. Feasibility study to assess the delivery of a lifestyle intervention (TreatWELL) for patients with colorectal cancer undergoing potentially curative treatment. BMJ Open 2018; 8:e021117. [PMID: 29880567 PMCID: PMC6009630 DOI: 10.1136/bmjopen-2017-021117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/27/2018] [Accepted: 04/20/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To assess the feasibility of delivering and evaluating a lifestyle programme for patients with colorectal cancer undergoing potentially curative treatments. STUDY DESIGN Non-randomised feasibility trial. SETTING National Health Service (NHS) Tayside. PARTICIPANTS Adults with stage I-III colorectal cancer. INTERVENTION The programme targeted smoking, alcohol, physical activity, diet and weight management. It was delivered in three face-to-face counselling sessions (plus nine phone calls) by lifestyle coaches over three phases (1: presurgery, 2: surgical recovery and 3: post-treatment recovery). PRIMARY OUTCOME Feasibility measures (recruitment, retention, programme implementation, achieved measures, fidelity, factors affecting protocol adherence and acceptability). SECONDARY OUTCOMES Measured changes in body weight, waist circumference, walking and self-reported physical activity, diet, smoking, alcohol intake, fatigue, bowel function and quality of life. RESULTS Of 84 patients diagnosed, 22 (26%) were recruited and 15 (18%) completed the study. Median time for intervention delivery was 5.5 hours. Coaches reported covering most (>70%) of the intervention components but had difficulties during phase 2. Evaluation measures (except walk test) were achieved by all participants at baseline, and most (<90%) at end of phase 2 and phase 3, but <20% at end of phase 1. Protocol challenges included limited time between diagnosis and surgery and the presence of comorbidities. The intervention was rated highly by participants but limited support from NHS staff was noted. The majority of participants (77%) had a body mass index>25 kg/m2 and none was underweight. Physical activity data showed a positive trend towards increased activity overall, but no other changes in secondary outcomes were detected. CONCLUSIONS To make this intervention feasible for testing as a full trial, further research is required on (a) recruitment optimisation, (b) appropriate assessment tools, (c) protocols for phase 2 and 3, which can build in flexibility and (d) ways for NHS staff to facilitate the programme. TRIAL REGISTRATION NUMBER ISRCTN52345929; Post-results.
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Affiliation(s)
- Maureen Macleod
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Robert J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Ronan E O'Carroll
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Mary Wells
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Anna Campbell
- Department of Sport Exercise and Health Science, School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | - Jacqui A Sugden
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Jackie Rodger
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Martine Stead
- Institute for Social Marketing, University of Stirling and the Open University, Stirling, UK
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling and the Open University, Stirling, UK
| | - Annie S Anderson
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
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22
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Webb J, Stockwell J, Chavez-Ugalde Y. The reach, adoption, and effectiveness of online training for healthcare professionals. Public Health 2017; 153:107-110. [PMID: 28988148 DOI: 10.1016/j.puhe.2017.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/07/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- J Webb
- London Metropolitan University, School of Social Professions, London, N7 8DB, UK.
| | - J Stockwell
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK.
| | - Y Chavez-Ugalde
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK.
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23
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Simapivapan P, Hodge A, Boltong A. Exploring the provision of alcohol advice by clinicians to breast cancer patients. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28745015 DOI: 10.1111/ecc.12739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 12/16/2022]
Abstract
Interactions between clinicians and patients along the cancer trajectory provide an opportunity to deliver key messages regarding drinking behaviours and long-term health. This study aimed to explore the extent and nature of clinician-patient discussions regarding alcohol intake and cancer outcomes in the clinical breast cancer setting, using a qualitative research design involving semi-structured interviews. Purposive sampling was used to recruit 27 breast cancer clinicians (eight dietitians, nine breast care nurses, 10 oncologists) across Victoria, Australia. Interview data were analysed using descriptive statistics and a content analysis approach. Clinicians' knowledge of national alcohol recommendations was found to be inconsistent. Clinicians reported a lack of patient awareness of the link between alcohol and breast cancer. Current frameworks for assessing and advising on patient alcohol intake were felt to be impractical. The extent and nature of advice provided about alcohol was influenced by several patient and clinician factors. The provision of alcohol advice in the clinical breast cancer setting is not practiced systematically by any professional group. New approaches are needed to support patient education about alcohol intake and survivorship in the clinical oncology setting.
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Affiliation(s)
- P Simapivapan
- The University of Melbourne, Parkville, Vic., Australia
| | - A Hodge
- The University of Melbourne, Parkville, Vic., Australia.,Cancer Council Victoria, Melbourne, Vic., Australia
| | - A Boltong
- The University of Melbourne, Parkville, Vic., Australia.,Cancer Council Victoria, Melbourne, Vic., Australia
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24
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Luckman S, Xiao C, McLennan E, Anderson AS, Mutrie N, Moug SJ. An investigation into UK medical students’ knowledge of lifestyle factors on cancer. Scott Med J 2017; 62:110-114. [DOI: 10.1177/0036933017706896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and aim Lifestyle factor modification (alcohol, smoking, obesity, diet, physical activity) has the potential to reduce cancer incidence and cancer survival. This study assessed the knowledge of lifestyle factors and cancer in undergraduate medical students. Methods and results A total of 218 students (7 UK universities) completed an online survey of nine questions in three areas: knowledge (lifestyle factors and cancer); information sources; clinical practice (witnessed clinical counselling). Diet, alcohol, smoking and physical activity were recognised as lifestyle factors by 98% of responders, while only 69% reported weight. The links of lung cancer/smoking and alcohol/liver cancer were recognised by >90%, while only 10% reported weight or physical activity being linked to any cancer. University teaching on lifestyle factors and cancer was reported by 78%: 34% rating it good/very good. GPs were witnessed giving lifestyle advice by 85% of responders. Conclusions Most respondents were aware of a relationship between lifestyle factors and cancer, mainly as a result of undergraduate teaching. Further work may widen the breadth of knowledge, and potentially improve primary and secondary cancer prevention.
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Affiliation(s)
- S Luckman
- Undergraduate Medical School, University of Birmingham, UK
| | - C Xiao
- Undergraduate Medical School, University of Glasgow, UK
| | - E McLennan
- Undergraduate Medical School, University of Glasgow, UK
| | - AS Anderson
- Professor of Public Health Nutrition, Ninewells Medical School, Centre for Research into Cancer Prevention and Screening, Centre for Public Health Nutrition Research, Dundee, UK
| | - N Mutrie
- Professor of Physical Activity for Health, Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, UK
| | - SJ Moug
- Consultant Surgeon and Honorary Clinical Senior Lecturer, Department of Surgery, University of Glasgow, UK
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Anderson AS, Caswell S, Macleod M, Steele RJ, Berg J, Dunlop J, Stead M, Eadie D, O'Carroll RE. Health Behaviors and their Relationship with Disease Control in People Attending Genetic Clinics with a Family History of Breast or Colorectal Cancer. J Genet Couns 2017; 26:40-51. [PMID: 27312973 PMCID: PMC5258810 DOI: 10.1007/s10897-016-9977-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/23/2016] [Indexed: 01/08/2023]
Abstract
The current work aimed to assess health behaviors, perceived risk and control over breast/colorectal cancer risk and views on lifestyle advice amongst attendees at cancer family history clinics. Participants attending the East of Scotland Genetics Service were invited to complete a questionnaire (demographic data, weight and height, health behaviors and psycho-social measures of risk and perceived control) and to participate in an in-depth interview. The questionnaire was completed by 237 (49 %) of attendees, ranging from 18 to 77 years (mean age 46 (±10) years). Reported smoking rates (11 %) were modest, most (54 %) had a BMI > 25 kg/m2, 55 % had low levels of physical activity, 58 % reported inappropriate alcohol intakes and 90 % had fiber intakes indicative of a low plant diet. Regression analysis indicated that belief in health professional control was associated with higher, and belief in fatalism with poorer health behavior. Qualitative findings highlighted doubts about the link between lifestyle and cancer, and few were familiar with the current evidence. Whilst lifestyle advice was considered interesting in general there was little appetite for non-tailored guidance. In conclusion, current health behaviors are incongruent with cancer risk reduction guidance amongst patients who have actively sought advice on disease risk. There are some indications that lifestyle advice would be welcomed but endorsement requires a sensitive and flexible approach, and the acceptability of lifestyle interventions remains to be explored.
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Affiliation(s)
- Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Division of Cancer Research, University of Dundee, Mailbox 7, Level 7, Ninewells Medical School, Dundee, DD1 9SY, UK.
| | - Stephen Caswell
- Centre for Research into Cancer Prevention and Screening, Division of Cancer Research, University of Dundee, Mailbox 7, Level 7, Ninewells Medical School, Dundee, DD1 9SY, UK
| | - Maureen Macleod
- Centre for Research into Cancer Prevention and Screening, Division of Cancer Research, University of Dundee, Mailbox 7, Level 7, Ninewells Medical School, Dundee, DD1 9SY, UK
| | - Robert Jc Steele
- Centre for Research into Cancer Prevention and Screening, Division of Cancer Research, University of Dundee, Mailbox 7, Level 7, Ninewells Medical School, Dundee, DD1 9SY, UK
| | - Jonathan Berg
- East of Scotland Genetics Service, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Jacqueline Dunlop
- East of Scotland Genetics Service, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, UK
| | - Douglas Eadie
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, UK
| | - Ronan E O'Carroll
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
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Smith L, Croker H, Fisher A, Williams K, Wardle J, Beeken RJ. Cancer survivors’ attitudes towards and knowledge of physical activity, sources of information, and barriers and facilitators of engagement: A qualitative study. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12641] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/23/2022]
Affiliation(s)
- L. Smith
- Department of Life Sciences; The Cambridge Centre for Sport and Exercise Science; Anglia Ruskin University; Cambridge UK
| | - H. Croker
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - A. Fisher
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - K. Williams
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - J. Wardle
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - R. J. Beeken
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
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Lee AS, Ozakinci G, Leung S, Humphris G, Dale H, Hamlet N. Lifestyle change in the cancer setting using 'the teachable moment': protocol for a proof-of-concept pilot in a urology service. Pilot Feasibility Stud 2016; 2:65. [PMID: 27965880 PMCID: PMC5154035 DOI: 10.1186/s40814-016-0102-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has shown diagnosis or screening for cancer may be a 'teachable moment' for prevention through lifestyle change. Previous trials have been successful but have been delivered via national programmes targeting patients being screened for colorectal cancer. This manuscript reports the protocol for a proof-of-concept study to assess the feasibility and acceptability of a lifestyle change service targeting men suspected or diagnosed with cancer of the prostate in a secondary care cancer service within the UK. METHODS Lifestyle change will be promoted through integration of a lifestyle change service in a urology department in one NHS Board. The service is delivered by a Health Psychologist and uses motivational interviewing and behavioural change techniques to motivate and support patients to consider and address topics such as increasing physical activity and a healthy diet, smoking cessation, alcohol reduction and weight loss. A service evaluation will assess feasibility and acceptability via a patient experience survey, a survey exploring staff knowledge, attitudes and practice, pre- and post-intervention lifestyle behaviour survey and an audit of routine patient database. DISCUSSION This pilot will assess the viability of using cancer testing and diagnosis as a teachable moment for lifestyle change in a unique population (i.e. men with suspected cancer of the prostate). If successful, this approach offers potential for preventative services to enhance routine and person-centred clinical cancer care provided within secondary care settings.
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Affiliation(s)
- Alyssa Sara Lee
- Department of Urology, NHS Fife, Kirkcaldy, UK ; School of Medicine, University of St Andrews, Fife, St Andrews, Scotland KY16 9TF UK
| | - Gozde Ozakinci
- School of Medicine, University of St Andrews, Fife, St Andrews, Scotland KY16 9TF UK
| | - Steve Leung
- Department of Urology, NHS Fife, Kirkcaldy, UK
| | - Gerry Humphris
- School of Medicine, University of St Andrews, Fife, St Andrews, Scotland KY16 9TF UK
| | - Hannah Dale
- School of Medicine, University of St Andrews, Fife, St Andrews, Scotland KY16 9TF UK ; Department of Psychology, NHS Fife, Kirkcaldy, UK
| | - Neil Hamlet
- Department of Public Health, NHS Fife, Kirkcaldy, UK
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Beeken RJ, Williams K, Wardle J, Croker H. "What about diet?" A qualitative study of cancer survivors' views on diet and cancer and their sources of information. Eur J Cancer Care (Engl) 2016; 25:774-83. [PMID: 27349812 PMCID: PMC4995727 DOI: 10.1111/ecc.12529] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 12/28/2022]
Abstract
Given the abundance of misreporting about diet and cancer in the media and online, cancer survivors are at risk of misinformation. The aim of this study was to explore cancer survivors' beliefs about diet quality and cancer, the impact on their behaviour and sources of information. Semi-structured interviews were conducted with adult cancer survivors in the United Kingdom who had been diagnosed with any cancer in adulthood and were not currently receiving treatment (n = 19). Interviews were analysed using Thematic Analysis. Emergent themes highlighted that participants were aware of diet affecting risk for the development of cancer, but were less clear about its role in recurrence. Nonetheless, their cancer diagnosis appeared to be a prompt for dietary change; predominantly to promote general health. Changes were generally consistent with healthy eating recommendations, although dietary supplements and other non-evidence-based actions were mentioned. Participants reported that they had not generally received professional advice about diet and were keen to know more, but were often unsure about information from other sources. The views of our participants suggest cancer survivors would welcome guidance from health professionals. Advice that provides clear recommendations, and which emphasises the benefits of healthy eating for overall well-being, may be particularly well-received.
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Affiliation(s)
- R J Beeken
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - K Williams
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - H Croker
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
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Maxwell-Smith C, Zeps N, Hagger MS, Platell C, Hardcastle SJ. Barriers to physical activity participation in colorectal cancer survivors at high risk of cardiovascular disease. Psychooncology 2016; 26:808-814. [PMID: 27478009 DOI: 10.1002/pon.4234] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lifestyle factors including inadequate physical activity may contribute to increased risk of developing cardiovascular disease in colorectal cancer survivors. Identification of the barriers to physical activity is important for forming an evidence base of factors to target in future physical activity programs aimed at improving cardiovascular health in this population. METHODS Colorectal cancer survivors (N = 24) from St. John of God Subiaco Hospital participated in semi-structured interviews about their current physical activity behaviors and perceived barriers to physical activity. RESULTS Inductive thematic analysis of interviews revealed 5 overarching themes relating to barriers to physical activity: psychological barriers, environmental barriers, knowledge of guidelines, lack of practitioner support, and energy/age barriers. CONCLUSIONS Novel findings revealed participants' dependence on practitioner support, including a reliance on practitioners to recommend lifestyle change. Survivors also revealed that regular checkups to monitor cardiovascular risk replaced the need for healthy lifestyle changes. IMPLICATIONS With survivors holding the advice of clinicians in high regard, an opportunity exists for clinicians to facilitate lifestyle change. Health care professionals such as nurses can implement motivational strategies and provide additional health information during follow-up visits, to ensure long-term adherence. Individuals who reported psychological, motivational, and environmental barriers may benefit from interventions to improve self-regulation, planning, and problem-solving skills.
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Affiliation(s)
- Chloe Maxwell-Smith
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Nik Zeps
- Department of Oncology, St. John of God Hospital, Perth, Western Australia, Australia
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Cameron Platell
- Department of Oncology, St. John of God Hospital, Perth, Western Australia, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
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Hubbard G, Munro J, O’Carroll R, Mutrie N, Kidd L, Haw S, Adams R, Watson AJM, Leslie SJ, Rauchhaus P, Campbell A, Mason H, Manoukian S, Sweetman G, Treweek S. The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial with embedded feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundColorectal cancer (CRC) survivors are not meeting the recommended physical activity levels associated with improving their chances of survival and quality of life. Rehabilitation could address this problem.ObjectivesThe aims of the Cardiac Rehabilitation In Bowel cancer study were to assess whether or not cardiac rehabilitation is a feasible and acceptable model to aid the recovery of people with CRC and to test the feasibility and acceptability of the protocol design.DesignIntervention testing and feasibility work (phase 1) and a pilot randomised controlled trial with embedded qualitative study (phase 2), supplemented with an economic evaluation. Randomisation was to cardiac rehabilitation or usual care. Outcomes were differences in objective measures of physical activity and sedentary behaviour, self-reported measures of quality of life, anxiety, depression and fatigue. Qualitative work involved patients and clinicians from both cancer and cardiac specialties.SettingThree colorectal cancer wards and three cardiac rehabilitation facilities.ParticipantsInclusion criteria were those who were aged > 18 years, had primary CRC and were post surgery.ResultsPhase 1 (single site) – of 34 patient admissions, 24 (70%) were eligible and 4 (17%) participated in cardiac rehabilitation. Sixteen clinicians participated in an interview/focus group. Modifications to trial procedures were made for further testing in phase 2. Additionally, 20 clinicians in all three sites were trained in cancer and exercise, rating it as excellent. Phase 2 (three sites) – screening, eligibility, consent and retention rates were 156 (79%), 133 (67%), 41 (31%) and 38 (93%), respectively. Questionnaire completion rates were 40 (97.5%), 31 (75%) and 25 (61%) at baseline, follow-up 1 and follow-up 2, respectively. Forty (69%) accelerometer data sets were analysed; 20 (31%) were removed owing to invalid data.Qualitative studyCRC and cardiac patients and clinicians were interviewed. Key themes were benefits and barriers for people with CRC attending cardiac rehabilitation; generic versus disease-specific rehabilitation; key concerns of the intervention; and barriers to participation (CRC participants only).Economic evaluationThe average out-of-pocket expenses of attending cardiac rehabilitation were £50. The costs of cardiac rehabilitation for people with cancer are highly dependent on whether it involves accommodating additional patients in an already existing service or setting up a completely new service.Limitations and conclusionsThe main limitation is that this is a small feasibility and pilot study. The main novel finding is that cardiac rehabilitation for cancer and cardiac patients together is feasible and acceptable, thereby challenging disease-specific rehabilitation models.Future workThis study highlighted important challenges to doing a full-scale trial of cardiac rehabilitation but does not, we believe, provide sufficient evidence to reject the possibility of such a future trial. We recommend that any future trial must specifically address the challenges identified in this study, such as suboptimal consent, completion, missing data and intervention adherence rates and recruitment bias, and that an internal pilot trial be conducted. This should have clear ‘stop–proceed’ rules that are formally reviewed before proceeding to the full-scale trial.Trial registrationCurrent Controlled Trials ISRCTN63510637.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 4, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gill Hubbard
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
| | - Julie Munro
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
| | - Ronan O’Carroll
- School of Natural Sciences, University of Stirling, Stirling, UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Lisa Kidd
- Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK
| | - Sally Haw
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
| | - Richard Adams
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Angus JM Watson
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
- NHS Highland, Raigmore Hospital, Inverness, UK
| | - Stephen J Leslie
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
- NHS Highland, Raigmore Hospital, Inverness, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Anna Campbell
- Edinburgh Napier University, Faculty of Life Science, Sport and Social Sciences, Edinburgh, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Kanera IM, Bolman CAW, Willems RA, Mesters I, Lechner L. Lifestyle-related effects of the web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) intervention for cancer survivors: a randomized controlled trial. J Cancer Surviv 2016; 10:883-97. [PMID: 26984534 PMCID: PMC5018034 DOI: 10.1007/s11764-016-0535-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
Purpose The web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) responds to the needs of cancer survivors and oncology care providers to improve the counseling related to self-management of lifestyle and psychosocial challenges. In present study, overall intervention effects and the effects of using specific components were evaluated on vegetable, fruit, whole grain bread, and fish consumption, physical activity (PA), and smoking behavior. Methods Cancer survivors from 21 Dutch hospitals were recruited for a randomized controlled trial (N = 432). Intervention effects after 6 months were evaluated using multilevel linear regression analysis (complete cases and intention-to-treat). By conducting moderation analyses, additional effects of following the behavior-related modules were explored. The false discovery rate correction was applied to account for multiple testing. Results After 6 months, 409 participants completed follow-up (dropout = 11.5 %). Indications were found that access to the intervention may result in increases of moderate PA and vegetable intake. The moderate PA increase was meaningful: 74.74 min p/w higher increase in the intervention condition. Effect sizes of moderate PA (d = .25) and vegetable (d = .37) consumption were comparable to prior effective interventions. Visiting behavior-related modules affected moderate PA, fruit, and fish consumption. However, after correction for multiple testing, significances expired. No significant intervention effect was found on smoking behavior due to low numbers of smokers. Implications for Cancer Survivors Although the effectiveness was only shown only to a limited extend, this study provided several indications that this theory-based, comprehensive, and personalized eHealth intervention provides valuable content to complement usual cancer aftercare.
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Affiliation(s)
- Iris M. Kanera
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Catherine A. W. Bolman
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Roy A. Willems
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Ilse Mesters
- CAPHRI School for Public Health and Primary Care, Optimizing Patient Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
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Webb J, Foster J, Poulter E. Increasing the frequency of physical activity very brief advice for cancer patients. Development of an intervention using the behaviour change wheel. Public Health 2016; 133:45-56. [PMID: 26822162 DOI: 10.1016/j.puhe.2015.12.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/20/2015] [Accepted: 12/20/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Being physically active has multiple benefits for cancer patients. Despite this only 23% are active to the national recommendations and 31% are completely inactive. A cancer diagnosis offers a teachable moment in which patients might be more receptive to lifestyle changes. Nurses are well placed to offer physical activity advice, however, only 9% of UK nurses involved in cancer care talk to all cancer patients about physical activity. A change in the behaviour of nurses is needed to routinely deliver physical activity advice to cancer patients. As recommended by the Medical Research Council, behavioural change interventions should be evidenced-based and use a relevant and coherent theoretical framework to stand the best chance of success. OBJECTIVE This paper presents a case study on the development of an intervention to improve the frequency of delivery of very brief advice (VBA) on physical activity by nurses to cancer patients, using the Behaviour Change Wheel (BCW). METHOD The eight composite steps outlined by the BCW guided the intervention development process. An iterative approach was taken involving key stakeholders (n = 45), with four iterations completed in total. This was not defined a priori but emerged during the development process. RESULTS A 60 min training intervention, delivered in either a face-to-face or online setting, with follow-up at eight weeks, was designed to improve the capability, opportunity and motivation of nurses to deliver VBA on physical activity to people living with cancer. This intervention incorporates seven behaviour change techniques of goal setting coupled with commitment; instructions on how to perform the behaviour; salience of the consequences of delivering VBA; a demonstration on how to give VBA, all delivered via a credible source with objects added to the environment to support behavioural change. CONCLUSION The BCW is a time consuming process, however, it provides a useful and comprehensive framework for intervention development and greater control over intervention replication and evaluation.
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Affiliation(s)
- J Webb
- Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK.
| | - J Foster
- Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK
| | - E Poulter
- Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK
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Hubbard G, Adams R, Campbell A, Kidd L, Leslie SJ, Munro J, Watson A. Is referral of postsurgical colorectal cancer survivors to cardiac rehabilitation feasible and acceptable? A pragmatic pilot randomised controlled trial with embedded qualitative study. BMJ Open 2016; 6:e009284. [PMID: 26729381 PMCID: PMC4716214 DOI: 10.1136/bmjopen-2015-009284] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/28/2015] [Accepted: 10/19/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES (1) Assess whether cardiac rehabilitation (CR) is a feasible and acceptable model of rehabilitation for postsurgical colorectal cancer (CRC) survivors, (2) evaluate trial procedures. This article reports the results of the first objective. DESIGN AND SETTING A pragmatic pilot randomised controlled trial with embedded qualitative study was conducted in 3 UK hospitals with CR facilities. Descriptive statistics were used to summarise trial parameters indicative of intervention feasibility and acceptability. Interviews and focus groups were conducted and data analysed thematically. PARTICIPANTS People with CRC were considered for inclusion in the trial if they were ≥ 18 years old, diagnosed with primary CRC and in the recovery period postsurgery (they could still be receiving adjuvant therapy). 31% (n=41) of all eligible CRC survivors consented to participate in the trial. 22 of these CRC survivors, and 8 people with cardiovascular disease (CVD), 5 CRC nurses and 6 CR clinicians participated in the qualitative study. INTERVENTION Referral of postsurgical CRC survivors to weekly CR exercise classes and information sessions. Classes included CRC survivors and people with CVD. CR nurses and physiotherapists were given training about cancer and exercise. RESULTS Barriers to CR were protracted recoveries from surgery, ongoing treatments and poor mobility. No adverse events were reported during the trial, suggesting that CR is safe. 62% of participants completed the intervention as per protocol and had high levels of attendance. 20 health professionals attended the cancer and exercise training course, rating it as excellent. Participants perceived that CR increased CRC survivors' confidence and motivation to exercise, and offered peer support. CR professionals were concerned about CR capacity to accommodate cancer survivors and their ability to provide psychosocial support to this group of patients. CONCLUSIONS CR is feasible and acceptable for postsurgical CRC survivors. A large-scale effectiveness trial of the intervention should be conducted. TRIAL REGISTRATION NUMBER ISRCTN63510637.
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Affiliation(s)
- Gill Hubbard
- School of Health Sciences, University of Stirling, Inverness, UK
| | - Richard Adams
- Institute of Cancer & Genetics, Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Anna Campbell
- Faculty of Life Science, Sport and Social Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lisa Kidd
- Faculty of Health and Social Care, Robert Gordon University Aberdeen, UK
| | | | - Julie Munro
- School of Health Sciences, University of Stirling, Inverness, UK
| | - Angus Watson
- NHS Highland, Colorectal Surgery, Raigmore Hospital, Inverness, UK
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Fisher A, Smith L, Wardle J. Physical activity advice could become part of routine care for colorectal cancer survivors. Future Oncol 2016; 12:139-41. [DOI: 10.2217/fon.15.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Abigail Fisher
- Department of Epidemiology & Public Health, Health Behaviour Research Centre, University College London, London, WC1E 6BT, UK
| | - Lee Smith
- Department of Epidemiology & Public Health, Health Behaviour Research Centre, University College London, London, WC1E 6BT, UK
| | - Jane Wardle
- Department of Epidemiology & Public Health, Health Behaviour Research Centre, University College London, London, WC1E 6BT, UK
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Karvinen K, Bruner B, Truant T. Lifestyle Counseling Practices of Oncology Nurses in the United States and Canada. Clin J Oncol Nurs 2015; 19:690-6. [DOI: 10.1188/15.cjon.690-696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fisher A, Williams K, Beeken R, Wardle J. Recall of physical activity advice was associated with higher levels of physical activity in colorectal cancer patients. BMJ Open 2015; 5:e006853. [PMID: 25922098 PMCID: PMC4420935 DOI: 10.1136/bmjopen-2014-006853] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The present study tested the hypothesis that recall of receiving physical activity (PA) advice would be associated with higher levels of PA in patients with a diagnosis of colorectal cancer (CRC). SETTING Colorectal cancer patients who were diagnosed in 2010 or 2011, and had been treated in the English National Health Service (NHS). PARTICIPANTS 17,753 respondents completed at least one section of the survey relevant to the current study and after exclusion of 171 with dementia (since results relied on recall), 15,254 had complete data for the current study. 60% were male, 67% were >65 years and 96% were from a white ethnic group. PRIMARY AND SECONDARY OUTCOME MEASURES Patients completed the 'Living with and Beyond Colorectal Cancer' Patient-Reported Outcome Measures (PROMS) survey in 2013. The survey included questions on receiving exercise advice/information ('PA advice'), and the frequency of currently doing at least 30 min of brisk PA per day ('PA level': 0, 1-4 or 5-7 days, within the past week; with the top category meeting UK guidelines). RESULTS A third of respondents (31%) recalled receiving PA advice. Independent of demographics and treatment, patients who recalled having PA advice were more likely to be currently doing some brisk PA (51% in the advice group vs 42% in the no advice group; OR 1.74, 95% CI 1.60 to 1.90; p<0.001), and more likely to be meeting PA guidelines (25% vs 20%; OR 1.70, CI 1.54 to 1.88; p<0.001). CONCLUSIONS Recalling being given PA advice after a diagnosis of CRC was associated with higher levels of PA. However, less than a third of patients recalled receiving advice. Future research should examine the context in which advice is given and randomised trials are required. However, encouraging clinicians working with patients with CRC to give brief PA advice is warranted and may help improve outcomes for CRC survivors.
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Affiliation(s)
- A Fisher
- Department of Epidemiology and Public Health, University College London, London, UK
| | - K Williams
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R Beeken
- Department of Epidemiology and Public Health, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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Williams K, Beeken RJ, Fisher A, Wardle J. Health professionals' provision of lifestyle advice in the oncology context in the United Kingdom. Eur J Cancer Care (Engl) 2015; 24:522-30. [PMID: 25732397 DOI: 10.1111/ecc.12305] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 01/04/2023]
Abstract
A healthy lifestyle following a cancer diagnosis is linked with better long-term outcomes. Health professionals can play an important role in promoting healthy lifestyles after cancer, but little is known about the factors that influence whether or not they give lifestyle advice. We conducted an online survey to examine levels of, and predictors of, health professionals' provision of lifestyle advice to cancer patients in the United Kingdom. The survey included questions on awareness of lifestyle guidelines for cancer survivors, current practices with regard to giving advice on smoking, diet, exercise, weight and alcohol, and perceived barriers to giving advice. Nurses, surgeons and physicians (N=460) responded to the survey. Many (36%) were not aware of any lifestyle guidelines for cancer survivors, but 87% reported giving some lifestyle advice; although this was lower for individual behaviours and often to <50% of patients. Respondents who were aware of lifestyle guidelines were more likely to give lifestyle advice on all behaviours (all OR's>1.76, all P's<0.05). Not believing lifestyle would affect outcomes was associated with lower odds of giving lifestyle advice (all OR's<0.48, all P's<0.05). Improved survivorship education for health professionals may increase the number of patients receiving lifestyle advice, and improve their long-term outcomes.
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Affiliation(s)
- K Williams
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - R J Beeken
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - A Fisher
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - J Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
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