Pearson Elizabeth J M, Morris Meg E, McKinstry Carol E
La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, 3552, Australia.
La Trobe University, School of Allied Health, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.
BMC Health Serv Res. 2017 Jul 18;17(1):496. doi: 10.1186/s12913-017-2415-9.
Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies.
A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round.
Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management.
Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may be further enhanced with guideline adaptation, professional education and integration with existing practices.
癌症相关疲劳（CRF）是癌症患者的一个关键问题，会损害身体机能和日常生活活动。虽然有基于证据的CRF指南，但在全球范围内的实施并不一致。本研究旨在确定应用癌症疲劳指南的障碍和促进因素，并得出实施策略。
一项混合方法研究探讨了实施加拿大心理社会肿瘤学协会（CAPO）制定的CRF指南的可行性。来自不同实践环境的卫生专业人员、管理人员和消费者参与了一项经过修改的两轮德尔菲研究。一个参考小组为包括调查在内的研究设计提供了信息。第一轮聚焦于指南特征、与当前实践和经验的兼容性以及行为改变。第二轮调查在第一轮的基础上进行，并进行了三角验证。
45名卫生从业者和管理人员以及68名癌症幸存者完成了调查。超过75%的参与者认可CAPO癌症相关疲劳指南。一些受访者认为缺乏可及的专业疲劳管理服务资源。指南实施的进一步障碍包括复杂性、某些要素的实际细节有限以及缺乏评估工具或患者教育材料等临床工具。提高指南适用性的建议围绕四个主要主题：（1）在CAPO指南的详细程度与易用性之间取得平衡，（2）界定不同专业学科在CRF管理中的作用，（3）如何最好地将CRF管理纳入政策和实践，（4）如何最好地确保以消费者为中心的CRF管理方法。
通过采用有效的指南，可以加强将当前关于CRF最佳管理的知识转化为临床实践。本研究表明采用CAPO指南是可行的。通过指南调整、专业教育以及与现有实践相结合，临床应用可能会进一步得到加强。
