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

BACKGROUND

Clinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow.

METHODS

For this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed.

RESULTS

Initial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants' performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility).

CONCLUSIONS

Implementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment.

Utilization of Isometric Strength Training and Interval Training With a Patient With Cancer in the Acute Care Setting

The onset of cancer and subsequent treatments often result in deficits in physical function and quality of life (QoL). Available research has demonstrated that an individualized exercise program has the ability to reduce fatigue, optimize physical function, and improve QoL. However, the exercise program is often lacking appropriate intensity and volume resulting in negligent improvement or even further reduction in function. Thus, the purpose of this case report is to demonstrate the application of isometric strength training (IST) and high-intensity interval training (HIIT) in the acute care setting with an individual with a history of malignant mesothelioma. The patient demonstrated improvement in functional mobility evidenced by improvement in Activity Measure for Post-Acute Care (AM-PAC) score through the hospitalization along with increased ambulation distance. No adverse events occurred during any physical therapy (PT) visits while utilizing HIIT or IST.