Bayly Joanne, Edwards Bethany M, Peat Nicola, Warwick Geoffrey, Hennig Ivo M, Arora Arvind, Wilcock Andrew, Higginson Irene J, Maddocks Matthew
1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, Bessemer Road, Denmark Hill, London, SE5 9PJ UK.
2Guy's & St Thomas's NHS Foundation Trust, London, UK.
Pilot Feasibility Stud. 2018 Oct 18;4:160. doi: 10.1186/s40814-018-0350-0. eCollection 2018.
Access to rehabilitation to prevent disability and optimise function is recommended for patients with cancer, including following cancer diagnosis. Models to integrate rehabilitation within oncology services as cancer treatment commences are required, but must be informed by those they are intended to support. We aimed to identify views of patients, carers and clinicians to develop and refine a rehabilitation model to be tested in a feasibility trial for people newly diagnosed with lung cancer or mesothelioma.
We conducted a focus group study with people affected by lung cancer or mesothelioma, their carers and clinicians providing their care to identify priorities for rehabilitation in this period. We sought views on core intervention components, processes and outcomes and integration with oncology services. Data were analysed using thematic analysis.
Fifteen clinicians (oncologists, nurse specialists, physiotherapists and occupational therapists), nine patients and five carers participated. A proposed outline rehabilitation model was perceived as highly relevant for this population. Participants recommended prompt and brief rehabilitation input, delivered whilst people attend for hospital appointments or at home to maximise accessibility and acceptability. Participants recognised variation in need and all prioritised tailored support for symptom self-management, daily activities and the involvement of carers. Clinicians also prioritised achieving fitness for oncology treatment. Patients and carers prioritised a sensitive manner of approach, positivity and giving hope for the future. Participant's recommendations for outcome measurement related to confidence in usual daily activities, symptom control and oncology treatment completion rates over objective measures of cardiorespiratory fitness.
The importance of providing tailored rehabilitation around the time of diagnosis for people with lung cancer or mesothelioma was affirmed by all participants. The refined model of rehabilitation recommended for testing in a feasibility trial is flexible, tailored and short-term. It aims to support people to self-manage symptoms, tolerate cancer treatments and to remain active and independent in daily life. It is delivered alongside scheduled hospital appointments or at home by an expert practitioner sensitive to the psycho-social sequelae that follow a diagnosis of thoracic cancer.
建议癌症患者，包括在癌症确诊后，接受康复治疗以预防残疾并优化功能。需要在癌症治疗开始时将康复纳入肿瘤服务的模式，但必须以其 intended to support 的人群的意见为依据。我们旨在确定患者、护理人员和临床医生的意见，以开发和完善一种康复模式，用于在一项针对新诊断为肺癌或间皮瘤的患者的可行性试验中进行测试。
我们对受肺癌或间皮瘤影响的患者、他们的护理人员以及提供护理的临床医生进行了焦点小组研究，以确定这一时期康复的优先事项。我们征求了关于核心干预组成部分、流程和结果以及与肿瘤服务整合的意见。使用主题分析对数据进行了分析。
15 名临床医生（肿瘤学家、护士专家、物理治疗师和职业治疗师）、9 名患者和 5 名护理人员参与了研究。一个提议的康复模式大纲被认为与该人群高度相关。参与者建议在患者前往医院就诊或在家时提供及时且简短的康复干预，以最大限度地提高可及性和可接受性。参与者认识到需求存在差异，并且都将针对症状自我管理、日常活动以及护理人员参与的个性化支持列为优先事项。临床医生还将实现适合肿瘤治疗的身体状况列为优先事项。患者和护理人员则将敏感的沟通方式、积极态度以及对未来的希望列为优先事项。参与者对结果测量的建议涉及对日常活动的信心、症状控制以及肿瘤治疗完成率，而非心肺功能的客观测量指标。
所有参与者都肯定了在肺癌或间皮瘤患者诊断时提供个性化康复的重要性。建议在可行性试验中进行测试的完善后的康复模式灵活、个性化且短期。其目的是支持人们自我管理症状、耐受癌症治疗，并在日常生活中保持活跃和独立。该模式由对胸癌诊断后的心理社会后遗症敏感的专家从业者在预定的医院就诊期间或在家中提供。
