Usability, acceptability, and implementation strategies for the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm: a Delphi study

Patient experiences of participating in a cancer rehabilitation triage and referral system in the Irish healthcare system

BACKGROUND

Screening, triage and referral systems can support patients to become more physically active and receive the right level of rehabilitation. This study aimed to understand patient experiences of attending a physiotherapy-led triage and referral clinic.

METHODS

Adults who had been diagnosed with cancer during COVID-19 (March 2020 to May 2022) and had completed treatment were invited to attend a physiotherapy-led triage and referral clinic for assessment and triage to one of three needs-based pathways. Participant experiences were captured via semi-structured interviews at 12-weeks post triage assessment. The Consolidated Framework for Implementation Research (CFIR) was used to design interview guides and to guide deductive analysis.

RESULTS

Twenty-six participants (male n = 15, mean age 65 (11.6) years, mean 28.5 (6) months post-diagnosis) were interviewed. Key findings were substantial unmet needs and a sense of being unsupported (outer setting), an individual assessment with the specialist physiotherapist was gratefully received (outer setting), cancer rehabilitation services must improve (intervention characteristics), rehabilitation is a worthwhile investment for the health service (inner setting) and ability varies amongst participants to absorb community service costs (intervention characteristics).

CONCLUSION

Findings indicate high participant satisfaction with personalised assessment and referral to exercise services. The opportunity to meet with a specialist physiotherapist was highly valued by participants across all levels, addressed a significant unmet service need and led to improvements in multiple unmet physical and psychosocial needs.

IMPLICATIONS FOR CANCER SURVIVORS

Triage and referral systems have significant potential to support implementation of exercise and rehabilitation pathways into cancer care with high patient satisfaction.

TRIAL REGISTRATION

CLINICALTRIALS

gov Identifier: NCT05615285.

Healthcare provider perspectives on a clinical decision tool to support individualized exercise prescriptions and discussions for breast cancer survivors

PURPOSE

We evaluated healthcare providers' current knowledge, practices, and perspectives on a novel clinical decision tool (beta-version) to facilitate individualized exercise prescriptions and discussions in clinical settings.

METHODS

We recruited healthcare providers who had treated or provided care to breast cancer survivors aged ≥ 35-years in the past 12 months. The participants were presented with a tool to provide individualized exercise recommendations considering women's individual, clinical, and contextual characteristics. Validated and reliable pre-existing instruments were used to survey providers' current knowledge, practices regarding exercise discussions, and perspectives on the beta-version (paper-draft) of the novel tool.

RESULTS

The sample consisted of complete survey responses from 177 healthcare providers including breast oncologists (27.7%), primary care physicians (10.7%), exercise specialists (19.8%), occupational/physical therapists (18.1%), advanced care providers, nurses, navigators, and social workers (23.7%). Median years of experience was 8-years (range: 5-13). Overall, 62.1% (n = 110) reported that they were knowledgeable about counseling survivors based on exercise guidelines. Among breast oncologists and primary care physicians (n = 68), only 39.7% reported that they were knowledgeable about identifying patients for exercise referals. The majority agreed that they would find the tool offering individualized information useful (n = 148, 83.6%), and would use it regularly to inform practice (82.5%). 'Exercise Readiness', 'Exercise Resources at Home', and 'Quality-of-Life' were the highest rated items for inclusion in the tool for exercise prescriptions. Provider perspectives were incorporated into the beta-version of the tool.

CONCLUSION

A clinical decision tool considering individual, clinical, and contextual characteristics may support exercise prescriptions and discussions in clinical settings.

IMPLICATIONS FOR CANCER SURVIVORS

An evidence-based tool for exercise prescriptions may increase healthcare provider confidence to discuss, educate, encourage, and provide exercise referrals for breast cancer survivors.

Identification of core competencies for exercise oncology professionals: A Delphi study of United States and Australian participants

INTRODUCTION

Integration of exercise into standard oncology care requires a highly skilled workforce of exercise professionals; however, competency requirements have not kept pace with advancements in the field. Therefore, the aim of this study was to obtain consensus on core competencies required for an exercise professional to be qualified to work with adults undergoing active cancer treatment.

MATERIALS AND METHODS

A three-round modified electronic Delphi process was used. In Round 1, an international group of 64 exercise oncology stakeholders (i.e., exercise oncology professionals (n = 29), clinical referrers (n = 21), and people with lived experience (n = 14)) responded to open-ended prompts eliciting perspectives regarding competencies needed for an exercise oncology professional to work with adults receiving active cancer treatment. Subsequently, only exercise oncology professionals participated, ranking the importance of competencies. In Round 2, professionals received summary feedback, ranked new competencies generated from open-ended responses, and reranked competencies not reaching consensus. In the final round, professionals finalized consensus ranking and rated frequency and mastery level for each.

RESULTS

Consensus was reached on 103 core competencies required for exercise professionals to be qualified to deliver care to adults undergoing active cancer treatment. The core competencies represent 10 content areas and reflect the needs of clinical referrers and people with lived experience of receiving cancer treatment.

CONCLUSIONS

The core competencies identified reflect significant advancements in the field of exercise oncology. Results will underpin the development of education, certification, and employment requirements for exercise oncology professionals, providing a critical step toward achieving routine integration of exercise into standard oncology care.

A review of big data technology and its application in cancer care

The development of modern medical devices and information technology has led to a rapid growth in the amount of data available for health protection information, with the concept of medical big data emerging globally, along with significant advances in cancer care relying on data-driven approaches. However, outstanding issues such as fragmented data governance, low-quality data specification, and data lock-in still make sharing challenging. Big data technology provides solutions for managing massive heterogeneous data while combining artificial intelligence (AI) techniques such as machine learning (ML) and deep learning (DL) to better mine the intrinsic connections between data. This paper surveys and organizes recent articles on big data technology and its applications in cancer, dividing them into three different types to outline their primary content and summarize their critical role in assisting cancer care. It then examines the latest research directions in big data technology in cancer and evaluates the current state of development of each type of application. Finally, current challenges and opportunities are discussed, and recommendations are made for the further integration of big data technology into the medical industry in the future.

Suicide Risk Screening for Head and Neck Cancer Patients: An Implementation Study

OBJECTIVES

 There is limited research on suicide risk screening (SRS) among head and neck cancer (HNC) patients, a population at increased risk for suicide. To address this gap, this single-site mixed methods study assessed oncology professionals' perspectives about the feasibility, acceptability, and appropriateness of an electronic SRS program that was implemented as a part of routine care for HNC patients.

METHODS

Staff who assisted with SRS implementation completed (e.g., nurses, medical assistants, advanced practice providers, physicians, social workers) a one-time survey (N = 29) and interview (N = 25). Quantitative outcomes were assessed using previously validated feasibility, acceptability, and appropriateness measures. Additional qualitative data were collected to provide context for interpreting the scores.

RESULTS

 Nurses and medical assistants, who were directly responsible for implementing SRS, reported low feasibility, acceptability, and appropriateness, compared with other team members (e.g., physicians, social workers, advanced practice providers). Team members identified potential improvements needed to optimize SRS, such as hiring additional staff, improving staff training, providing different modalities for screening completion among individuals with disabilities, and revising the patient-reported outcomes to improve suicide risk prediction.

CONCLUSION

 Staff perspectives about implementing SRS as a part of routine cancer care for HNC patients varied widely. Before screening can be implemented on a larger scale for HNC and other cancer patients, additional implementation strategies may be needed that optimize workflow and reduce staff burden, such as staff training, multiple modalities for completion, and refined tools for identifying which patients are at greatest risk for suicide.

Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study)

OBJECTIVE

To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic.

DESIGN

Semistructured qualitative interview study.

SETTING

National Health Service (NHS) trusts/health boards in England and Wales.

PARTICIPANTS

Clinicians from NHS trusts/health boards in England and Wales.

METHOD

Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions.

RESULTS

During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed.

CONCLUSION

This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic.

TRIAL REGISTRATION NUMBER

ISRCTN66682918.

Multimodal Physical Exercise and Functional Rehabilitation Program in Oncological Patients with Cancer-Related Fatigue-A Randomized Clinical Trial

The increase in life expectancy and survival time implies an increase in the possible side-effects of pharmacological treatments in patients. Cancer-related fatigue is one of these side-effects. The main objective of this study was to evaluate the effects of a multimodal program of physical exercise and functional rehabilitation on asthenia, pain, functional capacity, and quality of life in cancer patients with cancer-related fatigue.

METHODS

This was a randomized, parallel-controlled clinical trial, with two arms (experimental and control group), and it was conducted over the course of a year in the Oncology Hospitalization Unit at the University Hospital of Salamanca, Spain. Participants (n = 48) were assessed at three points during the study. The first assessment was prior to hospital discharge, the second assessment was after 15 days, and the final assessment was at one month post-hospital follow-up. The intervention lasted one month. The main variables studied were the dependency levels (Barthel), cancer-related fatigue (FACT-An), health-related quality of life (EuroQoL-5D), functional capacity (SPPB), and kinesiophobia (TSK-F).

RESULTS

Sample size (n = 44). Mean age 63.46 ± 12.36 years. Significant differences between control and experimental group participants in Barthel, FACT-An, TSK-F, and SPPB scores at follow-up and final assessment.

CONCLUSIONS

There are beneficial effects of a multimodal physical exercise and functional rehabilitation program in improving the autonomy of cancer-related fatigue patients.