Nurses' perspectives on physical activity promotion in cancer patients: A qualitative research

Promoting Physical Activity to Cancer Survivors in Practice: Challenges and Solutions for Implementation

Objectives: This study explored the challenges and solutions to the effective promotion of physical activity (PA) to cancer survivors in practice in Ireland amongst a variety of stakeholders, including healthcare professionals (HCPs), policy makers, community providers of cancer care, and academics. Methods: Focus groups (n = 5) were conducted with participants (n = 40), including oncologists, oncology nurses, physiotherapists, cancer support centre managers, academics, consumers, cancer policy representatives, exercise specialists, community providers of exercise programmes, and a chartered psychologist. The data were analysed using reflexive thematic analysis. Results: Four primary themes were identified: (i) embedding PA into the cancer pathway (including the sub-themes of 'singing from the same hymn sheet', 'PA as an essential element of treatment', and 'intervention opportunities and models of care'); (ii) education and training; (iii) access to appropriate PA interventions; and (iv) tailored programmes. Conclusions: The importance of embedding PA into the cancer pathway such that PA is viewed by clinicians and patients as a key part of their treatment was emphasised. Opportunities for PA intervention within existing practice were highlighted, such as the chemotherapy education sessions run by Daffodil nurses. Findings pointed to a need for education and training for HCPs that include how to coach and counsel cancer patients concerning PA in clinic. Finally, a major barrier to PA promotion was limited access to appropriate PA interventions.

A cross-sectional study exploring the perception of exercise oncology in the Italian population

Introduction

We aim to examine the population's perception of physical exercise in patients with cancer.

Materials and methods

An anonymous survey was conducted to reach a sample of Italian adults. The questionnaire investigated sociodemographic factors, physical exercise levels, and perceptions about the importance, benefits, and safety of exercise, the support from oncologists and family/friends, as well as the capability and ease of patients of exercise.

Results

Overall, 838 persons participated in this survey. The majority of respondents agree that exercise is important (60.5%) and beneficial (61.5%) for patients with cancer during anticancer treatments, whereas 40.2% believed in its safety. Forty-two percent and 51.9% of participants expressed a positive opinion regarding the advice of oncologists and the encouragement of family/friends to exercise, respectively. Only 27.2% of respondents feel that patients are capable of exercising, and 9.0% agree that it is easy for them.

Conclusion

Although the population has a favorable perception of the importance and benefits of physical exercise, they do not still believe that patients are capable of performing it. Increasing awareness of the feasibility of a physical exercise intervention in the context of cancer is crucial to supporting patients.

A cross-sectional study evaluating the exercise discussion with oncologist during cancer consultation: the CONNECT study

BACKGROUND

Evidence demonstrates that physical exercise confers several psycho-physical benefits on patients with cancer. This study aims to investigate the role of oncologists in exercise promotion.

PATIENTS AND METHODS

A multicenter, cross-sectional study was conducted by distributing an anonymous, self-administered questionnaire to patients with cancer. The questionnaire enclosed demographic, health, and exercise variables. The exercise-related questions included in the study used the Godin-Shephard Leisure-Time Physical Activity Questionnaire to measure the amount of physical exercise. In addition, the survey gathered information on whether exercise was discussed with patients, and whether oncologists followed the assess, advise, reinforce, and refer (AARR) process regarding exercise. The survey also asked if patients preferred that exercise be discussed during their consultations. Descriptive statistics and logistic regression were applied.

RESULTS

With a response rate of 75%, a total of 549 patients completed the survey. Regarding the exercise discussion, 38% of patients stated that their oncologist initiated an exercise discussion, 14% started the discussion themselves, and 48% said that the issue was not considered. Overall, 35% of patients reported that the oncologist assessed their exercise level, 22% and 42% received advice or reinforcement to increase their exercise, respectively, and 10% were referred to a dedicated service. Regarding preferences, 72% of patients thought that the oncologists should initiate an exercise discussion, 2% that only patients should start the discussion, and 26% thought that the issue should not be discussed. Similarly, 74% of patients are willing to receive the exercise assessment, 59% and 75% the advice and reinforcement to increase their exercise, and 46% to be referred to an exercise service.

CONCLUSIONS

Although exercise promotion rates are low, patients are willing to receive exercise information. Dedicated strategies should be developed to support oncologists in promoting exercise to their patients.

Practitioner perceptions on the use of exercise and nutritional interventions for patients with breast cancer receiving radiation therapy

INTRODUCTION

Radiation therapy treatment for breast cancer may negatively impact patients' health-related quality of life. Evidence suggests exercise and nutrition interventions may be beneficial to patients experiencing compromised health-related quality of life. This study investigates whether radiation oncology practitioners support the implementation of a tailored exercise and nutrition intervention for patients and explores their interest in participating in training for exercise and nutrition as interventions.

METHODS

Data were collected by an online survey, deployed to public and private radiation oncology departments, across three Australian states (Australian Capital Territory, New South Wales, Queensland). The survey was completed between June and August 2020. Radiation oncologists, radiation oncology registrars, radiation therapists and radiation oncology nurses completed the survey. The survey included demographics, patient assessment and questions regarding the radiation oncology practitioners' use of exercise and nutrition as interventions.

RESULTS

Of 192 practitioners targeted, 76 completed the survey, for a response rate of 40%. Of 76 respondents, 42% 'sometimes' recommended exercise and 41% 'sometimes' recommended nutrition as health-related quality of life interventions to their patients. The majority indicated they would benefit from more training in these subjects, with 58% for exercise and 55% for nutrition. 47 per cent of respondents thought patients would benefit from a tailored exercise and nutrition programme and 62% agreed they would refer patients to a programme if it were available.

CONCLUSIONS

Radiation oncology practitioners reported they need training in exercise and nutrition to better understand how this can benefit the health-related quality of life of breast cancer patients. Also, the findings indicate that if such an exercise and nutrition intervention were readily available, practitioners would refer patients who may benefit from this intervention.

Effects of Exercise on Motivational Outcomes in Rectal Cancer Patients During and After Neoadjuvant Chemoradiation: A Phase II Randomized Controlled Trial

OBJECTIVES

Understanding exercise motivation in rectal cancer patients during and after neoadjuvant chemoradiation therapy is important to improve adherence and achieve potential benefit. We report the motivational effects of exercise from the Exercise During and After Neoadjuvant Rectal Cancer Treatment trial.

DATA SOURCES

We randomized 36 rectal cancer patients to supervised high-intensity interval training during neoadjuvant chemoradiation therapy followed by unsupervised moderate-to-vigorous exercise after therapy, or usual care. Using the theory of planned behavior, we assessed motivation, perceived benefits/harms, and perceived barriers for exercise during and after therapy. Supervised exercise during neoadjuvant chemoradiation therapy was experienced as meaningfully (d≥0.33) more controllable (p=0.08, d=0.60), more enjoyable (p=0.25, d=0.45), and less difficult (p=0.45, d=-0.38) than anticipated. Unsupervised exercise after therapy was experienced as meaningfully more enjoyable (p=0.047, d=0.50) and less difficult (p=0.43, d=-0.36), but also less controllable (p=0.14, d=-0.80) than anticipated. Common self-reported benefits of exercise both during and after neoadjuvant chemoradiation therapy were cardiovascular endurance, physical functioning, and quality of life. Common self-reported harms were exacerbation of treatment side effects. Frequently reported barriers to exercise during therapy were side effects of treatment, whereas exercise barriers after therapy were lack of motivation and lingering side effects.

CONCLUSION

Exercise during and after therapy generally had positive effects on exercise motivation, however, perceived harms and barriers related to treatment side effects were identified.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can help rectal cancer patients initiate and maintain exercise during and after neoadjuvant chemoradiation by discussing the potential benefits, harms, and barriers to exercise.

Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies

PURPOSE

Physical activity can improve health outcomes for cancer patients; however, only 30% of patients are physically active. This review explored barriers to and facilitators of physical activity promotion and participation in patients living with and beyond cancer. Secondary aims were to (1) explore similarities and differences in barriers and facilitators experienced in head and neck cancer versus other cancers, and (2) identify how many studies considered the influence of socioeconomic characteristics on physical activity behaviour.

METHODS

CINAHL Plus, MEDLINE, PsycINFO, Scopus and Cochrane (CDSR) were searched for qualitative and mixed methods evidence. Quality assessment was conducted using the Mixed Methods Appraisal Tool and a Critical Appraisal Skills Programme Tool. Thematic synthesis and frequency of reporting were conducted, and results were structured using the Capability-Opportunity-Motivation-Behaviour model and Theoretical Domains Framework.

RESULTS

Thirty qualitative and six mixed methods studies were included. Socioeconomic characteristics were not frequently assessed across the included studies. Barriers included side effects and comorbidities (physical capability; skills) and lack of knowledge (psychological capability; knowledge). Having a dry mouth or throat and choking concerns were reported in head and neck cancer, but not across other cancers. Facilitators included improving education (psychological capability; knowledge) on the benefits and safety of physical activity.

CONCLUSION

Educating patients and healthcare professionals on the benefits and safety of physical activity may facilitate promotion, uptakeand adherence. Head and neck cancer patients experienced barriers not cited across other cancers, and research exploring physical activity promotion in this patient group is required to improve physical activity engagement.

Healthcare professionals feel empowered by implementing a hospital-based multifaceted intervention: a qualitative study using inductive thematic analysis

Background

Most patients are insufficiently physically active during their hospital stay, and this is associated with poor health and delayed recovery. Hospital-based multifaceted interventions aim to encourage patients to engage in physical activity. Ban Bedcentricity is one such intervention. Its value – and that of others similar to it – for healthcare professionals has not been studied yet. Whether an intervention looks and feels right, and whether it does the job well, is important for healthcare professionals and thus its use. Understanding value for healthcare professionals seems crucial for the long-term adoption and implementation of interventions. Therefore, we studied healthcare professionals’ perceptions of value in terms of the implementation of a multifaceted intervention that aimed at improving physically active behaviour in patients during their hospital stay.

Methods

Using Ban Bedcentricity as a case study to focus on healthcare professionals’ perceptions about multifaceted interventions, we conducted a qualitative study between November 2019 and September 2020. Semi-structured interviews were conducted with purposefully selected physicians, physiotherapists, and nurses (assistants) until theoretical data saturation was reached. Inductive thematic analysis was used to identify key themes and develop a conceptual model.

Results

We interviewed 15 healthcare professionals and formulated six key themes from these interviews. The participants said that Ban Bedcentricity empowered them in their beliefs about the importance of physical activity for hospitalized patients (theme 1). They also indicated that it made them more aware of the value of physical activity (theme 2) and skilled to promote physical activity as part of their professional role (theme 3). Similarly, they noted that it enabled them to shift from providing hands-on support to verbal coaching (theme 4). Other aspects that the participants valued were the increased possibilities for teamwork (theme 5) and the routinized physical activity promotion in usual care (theme 6). The challenges discussed by the participants were prioritizing activities that promoted physical activity, especially because of a high workload, and avoiding relapses of new routinized work practices related to physical activity promotion if insufficient long-term support and training were provided.

Conclusions

Our conceptual model shows that the implementation of a hospital-based multifaceted intervention by healthcare professionals empowers their beliefs, and improves their awareness, skills, professional roles, teamwork, and work routinization. These values are typically overlooked, despite potentially being important facilitators for long-term implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08310-w.