ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.
Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA.
Support Care Cancer. 2021 Nov;29(11):6469-6480. doi: 10.1007/s00520-021-06208-7. Epub 2021 Apr 26.
Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm.
From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format.
We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains.
The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.
参与运动或康复服务被推荐用于优化健康、功能和整体幸福感，贯穿癌症护理的全过程。然而，对个体需求的了解有限和复杂的决策过程是将合适的幸存者与合适的运动/康复服务在合适的时间联系起来的障碍。在本文中，我们定义了运动/康复服务的层次，提供了一个概念模型来提高对个体需求的理解，并描述了癌症评估和决策支持中的运动（EXCEEDS）算法的发展。
从文献综述中，我们综合了运动/康复服务的定义特征和与每种服务的安全性和有效性相关的个体特征。我们开发了一个可视化模型来概念化每个特定护理水平的需求，然后将个体特征组织成一个风险分层算法。通过多学科专家小组进行反复审查，直到就算法内容和格式达成共识。
我们确定了四级运动/康复服务的八个定义特征，并提供了一个概念模型，以指导在护理全过程中为每个服务进行个体化导航。EXCEEDS 算法包括一个风险分层的十一个二分问题系列，分为两部分和十个领域。
EXCEEDS 算法是一个基于证据的决策支持工具，它提供了一种描述运动/康复服务的通用语言，一个理解个体化需求的实用模型，以及逐步的决策支持指导。EXCEEDS 算法旨在由多学科用户（包括幸存者）在护理点或需求点使用，从而可能改善癌症运动/康复服务的协调。
