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Keeney T, Wu C, Savini A, Stone S, Travis A, Vranceanu AM, Steinhauser K, Greer J, Pastva AM, Ritchie C. Using Multiphase Optimization Strategy and Human-Centered Design to Create an Integrated Model of Palliative Care Skills in Home-Based Physical Therapy for Advanced Heart Failure. J Palliat Med 2024; 27:526-531. [PMID: 38394228 PMCID: PMC11000320 DOI: 10.1089/jpm.2023.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Many older adults with advanced heart failure receive home health rehabilitation after hospitalization. Yet, integration of palliative care skills into rehabilitation is limited. Objective: Describe using the Multiphase Optimization Strategy (MOST) framework with human-centered design principles to engage clinical partners in the Preparation phase of palliative physical therapy intervention development. Design: We convened a home-based physical therapy advisory team (four clinicians, three clinical leaders) to identify physical therapist needs and preferences for incorporating palliative care skills in rehabilitation and design an intervention prototype. Results: Between 2022 and 2023, we held five advisory team meetings. Initial feedback on palliative care skill preferences and training needs directly informed refinement of our conceptual model and skills in the intervention prototype. Later feedback focused on reviewing and revising intervention content, delivery strategy, and training considerations. Conclusion: Incorporating human-centered design principles within the MOST provided a useful framework to partner with clinical colleagues in intervention design.
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Affiliation(s)
- Tamra Keeney
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cecilia Wu
- Mass General Brigham Home Care, Boston, Massachusetts, USA
| | - Alicia Savini
- Mass General Brigham Home Care, Boston, Massachusetts, USA
| | - Sarah Stone
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aniyah Travis
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Steinhauser
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Joseph Greer
- Department of Psychiatry, Massachusetts General Hospital
| | - Amy M. Pastva
- Department of Orthopedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christine Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Wade-Mcbane K, King A, Urch C, Jeyasingh-Jacob J, Milne A, Boutillier CL. Prehabilitation in the lung cancer pathway: a scoping review. BMC Cancer 2023; 23:747. [PMID: 37568130 PMCID: PMC10416419 DOI: 10.1186/s12885-023-11254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Lung cancer is the third most common type of cancer in the UK. Treatment outcomes are poor and UK deaths from lung cancer are higher than any other cancer. Prehabilitation has shown to be an important means of preparing patients both physically and psychologically for cancer treatment. However, little is understood about the context and mechanisms of prehabilitation that can impact physiological and psychological wellbeing. Our aim was to review and summarise primary research on prehabilitation in the lung cancer pathway using a realist approach. METHODS A scoping review of empirical primary research was conducted. Five online medical databases from 2016 - February 2023 were searched. All articles reporting on prehabilitation in lung cancer were included in the review. For this review, prehabilitation was defined as either a uni-modal or multi-modal intervention including exercise, nutrition and/or psychosocial support within a home, community or hospital based setting. A realist framework of context, mechanism and outcome was used to assist with the interpretation of findings. RESULTS In total, 31 studies were included in the review, of which, three were published study protocols. Over 95% of studies featured an exercise component as part of a prehabilitation programme. Twenty-six of the studies had a surgical focus. Only two studies reported using theory to underpin the design of this complex intervention. There was large heterogeneity across all studies as well as a lack of clinical trials to provide definitive evidence on the programme design, setting, type of intervention, patient criteria, delivery, duration and outcome measures used. CONCLUSION A standardised prehabilitation programme for lung cancer patients does not yet exist. Future lung cancer prehabilitation programmes should take into account patient led values, needs, goals, support structures and beliefs, as these factors can affect the delivery and engagement of interventions. Future research should consider using a conceptual framework to conceptualise the living with and beyond cancer experience to help shape and inform personalised prehabilitation services.
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Affiliation(s)
- Kelly Wade-Mcbane
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Alex King
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Urch
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Julian Jeyasingh-Jacob
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Milne
- Medical Library, Hammersmith Campus, Imperial College London, London, UK
| | - Clair Le Boutillier
- Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Wade-Mcbane K, King A, Urch C, Johansson L, Wells M. Is personalised prehabilitation feasible to implement for patients undergoing oncological treatment for lung cancer at a London teaching hospital? Protocol of a feasibility trial. BMJ Open 2023; 13:e072367. [PMID: 37460263 PMCID: PMC10357652 DOI: 10.1136/bmjopen-2023-072367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION There is significant potential to improve outcomes for patients with lung cancer in terms of quality of life and survival. There is some evidence that prehabilitation can help, but, to date, this has only been tested in surgical populations, despite 70%-80% of patients with lung cancer in the UK receiving non-surgical treatment. The physiological and psychological benefits of prehabilitation seen in surgical patients could be extrapolated to those receiving non-surgical treatment, particularly in such a poor prognosis group. With patients and healthcare professionals, we have co-designed a personalised and evidence-based prehabilitation programme. This draws on a conceptual framework that aligns with patient values and needs as well as functional goals. We aim to investigate whether this programme is feasible to implement and evaluate in clinical practice. METHODS AND ANALYSIS An open-label, single-group feasibility study incorporating quantitative assessments, a qualitative free text questionnaire and reflective field notes. Thirty participants will be recruited over an eight-month period from a single London teaching hospital. All recruited participants will receive a personalised prehabilitation programme during their oncological treatment. This includes a one-hour face-to-face appointment prior to, at week three and at week six of their treatment regimen as well as a weekly telephone call. Interventions including nutrition, physical activity and psychological well-being are stratified according to a patient's priorities, level of readiness and expressed needs. The primary outcome will be feasibility of the personalised prehabilitation programme in clinical practice by investigating areas of uncertainty regarding patient recruitment, attrition, treatment fidelity, intervention adherence and acceptability of study outcome measures. Secondary outcomes will include quality of life, functional capacity and grip strength. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Health Research Authority (reference number 22/PR/0390). Results of this study will be disseminated through publication in peer-reviewed articles, presentations at scientific conferences and in collaboration with patient and public involvement representatives. TRIAL REGISTRATION NUMBER NCT05318807.
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Affiliation(s)
- Kelly Wade-Mcbane
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, UK
| | - Alex King
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Urch
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Lina Johansson
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, UK
| | - Mary Wells
- Department of Surgery and Oncology, Nursing Directorate, Imperial College Healthcare NHS Trust, London, UK
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Bayly J, Ahmedzai HH, Blandini MG, Bressi B, Caraceni AT, Carvalho Vasconcelos J, Costi S, Fugazzaro S, Guberti M, Guldin MB, Hauken M, Higginson I, Laird BJ, Ling J, Normand C, Nottelmann L, Oldervoll L, Payne C, Prevost AT, Stene GB, Vanzulli E, Veber E, Economos G, Maddocks M. Integrated Short-term Palliative Rehabilitation to improve quality of life and equitable care access in incurable cancer (INSPIRE): a multinational European research project. Palliat Care Soc Pract 2023; 17:26323524231179979. [PMID: 37377743 PMCID: PMC10291227 DOI: 10.1177/26323524231179979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Background Disability related to incurable cancer affects over a million Europeans each year and people with cancer rank loss of function among the most common unmet supportive care needs. Objectives To test the clinical and cost-effectiveness of an integrated short-term palliative rehabilitation intervention, to optimise function and quality of life in people affected by incurable cancer. Design This is a multinational, parallel group, randomised, controlled, assessor blind, superiority trial. Methods The INSPIRE consortium brings together leaders in palliative care, oncology and rehabilitation from partner organisations across Europe, with complementary expertise in health service research, trials of complex interventions, mixed-method evaluations, statistics and economics. Partnership with leading European civil society organisations ensures citizen engagement and dissemination at the highest level. We will conduct a multinational randomised controlled trial across five European countries, recruiting participants to assess the effectiveness of palliative rehabilitation for people with incurable cancer on the primary outcome - quality of life - and secondary outcomes including disability, symptom burden and goal attainment. To support trial conduct and enhance analysis of trial data, we will also conduct: comparative analysis of current integration of rehabilitation across oncology and palliative care services; mixed-method evaluations of equity and inclusivity, processes and implementation for the intervention, at patient, health service and health system levels. Finally, we will conduct an evidence synthesis, incorporating INSPIRE findings, and a Delphi consensus to develop an international framework for palliative rehabilitation practice and policy, incorporating indicators, core interventions, outcomes and integration methods. Scientific contribution If positive, the trial could produce a scalable and equitable intervention to improve function and quality of life in people with incurable cancer and reduce the burden of care for their families. It could also upskill the practitioners involved and motivate future research questions. The intervention could be adapted and integrated into different health systems using existing staff and services, with little or no additional cost.
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Affiliation(s)
- Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, 5 Bessemer Road, London SE59PJ, UK
| | | | | | - Barbara Bressi
- Physical Medicine and Rehabilitation Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Joana Carvalho Vasconcelos
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, King’s College London, London, UK
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - May Hauken
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Irene Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Barry J.A. Laird
- Western General Hospital and Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Charles Normand
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Lise Nottelmann
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, København, Denmark
| | - Line Oldervoll
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Cathy Payne
- European Association for Palliative Care, Vilvoorde, Belgium
| | - A. Toby Prevost
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, King’s College London, London, UK
| | - Guro B. Stene
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisa Vanzulli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Eduardo Veber
- European Cancer Patient Coalition, Brussels, Belgium
| | - Guillaume Economos
- Centre Hospitalier Lyon-Sud, Palliative Care Centre, Pierre-Benite, France
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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Ho S, Culligan M, Friedberg J, Goloubeva O, Marchese V. Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma. Disabil Rehabil 2022; 44:6676-6683. [PMID: 34455883 DOI: 10.1080/09638288.2021.1970256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of physical function performance and pulmonary function on patient outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM). MATERIALS AND METHODS A retrospective review of 54 patients with MPM from 2015 to 2020 was performed. The primary objective was to assess whether physical function, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG), and pulmonary function tests were predictive of postoperative patient outcomes (ventilator days, chest tube days, hospital length of stay). A secondary objective was to explore demographic and preoperative variables that best predict postoperative physical function and patient outcomes. RESULTS Data include 54 patients who underwent extended pleurectomy-decortication. Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability. Preoperative ECOG was also predictive of preoperative lung function. Age on the day of surgery was the best predictor of postoperative physical function, which was significantly reduced postoperatively. CONCLUSIONS Preoperative physical function performance was a significant predictor of postoperative outcomes. The results of our study highlight the importance of physical function in patients with MPM and support the need for early rehabilitation and further research to determine optimal rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONPreoperative physical function can predict outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM).Physical function in patients with MPM should be carefully examined.To accurately reflect patients' abilities, patient assessment should include both patient-reported outcomes and performance-based measures.Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care.
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Affiliation(s)
- Simon Ho
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa Culligan
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Olga Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.,Division of Biostatistics and Bioinformation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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