Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.
Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands.
J Cancer Surviv. 2022 Jun;16(3):497-513. doi: 10.1007/s11764-021-01045-3. Epub 2021 Sep 14.
This study evaluates the effectiveness and feasibility of two strategies to implement physical cancer rehabilitation (PCR) guidelines for patients who have survived abdominopelvic cavity malignancies.
We tested and compared two tailored strategies to implement PCR guidelines for survivors of gastrointestinal, female organ and urogenital organ malignancies, in a clustered controlled before-and-after study. A patient-directed (PD) strategy was tested in five cancer centers, aiming to empower survivors. A multifaceted (MF) strategy was tested in four cancer centers, aiming additionally to influence healthcare professionals and the healthcare organization. Data were collected from existing registration systems, patient questionnaires and professional questionnaires. We measured both implementation- and client outcomes. For insight into the effectiveness we measured indicators related to PCR guidelines: (1) screening with the Distress Thermometer (DT) (=primary outcome measure), (2) information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), (3) advice to take part in PA and PCRPs, (4) referral to PCRPs, (5) participation in PCRPs, (6) PA uptake (PAU); and patient reported outcomes (PROs) such as (7) quality of life, (8) fatigue, and (9) empowerment. Furthermore, survivor and center determinants were assessed as possible confounders. Multilevel analyses were performed to compare the scores of the indicators of the PD and MF strategies, as well as the differences between the characteristics of these groups. The use of and experiences with both strategies were measured using questionnaires and Google Analytics to assess feasibility.
In total, 1326 survivors participated in the study, 673 in the before- and 653 in the after-measurement. Regarding our primary outcome measure, we found a significant improvement of screening with the DT between the before- and after-measurement for both strategies, respectively from 34.2 to 43.1% (delta=8.9%; odds ratio (OR)=1.6706; p=0.0072) for the PD strategy and from 41.5 to 56.1% (delta=14.6%; OR=1.7098; p=0.0028) for the MF strategy. For both the primary and secondary outcomes, no statistically significant effect of the MF strategy compared to the PD strategy was observed. We found good use of and positive experiences with both strategies.
Implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT for survivors of abdominopelvic cavity malignancies. Further research is needed to assess the additional effectiveness of strategies that stimulate compliance among healthcare professionals and healthcare organizations.
Using implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT and might improve the quality of care of patients who have survived abdominopelvic cavity malignancies.
本研究评估了两种实施针对存活于腹盆腔恶性肿瘤患者的癌症康复物理治疗（PCR）指南策略的有效性和可行性。
我们在一项集群对照前后研究中，对胃肠道、女性器官和泌尿生殖器官恶性肿瘤幸存者的两种定制策略进行了测试和比较。患者导向（PD）策略在五家癌症中心进行测试，旨在增强幸存者的能力。多方面（MF）策略在四家癌症中心进行了测试，旨在另外影响医疗保健专业人员和医疗保健组织。数据来自现有登记系统、患者问卷和专业问卷。我们测量了实施和客户的结果。为了深入了解效果，我们测量了与 PCR 指南相关的指标：（1）使用困扰温度计（DT）进行筛查（=主要测量指标），（2）提供有关身体活动（PA）和癌症康复计划（PCRP）的信息，（3）建议参加 PA 和 PCRP，（4）转介到 PCRP，（5）参加 PCRP，（6）PA 参与（PAU）；以及患者报告的结果（PROs），如（7）生活质量，（8）疲劳，和（9）赋权。此外，还评估了幸存者和中心的决定因素作为可能的混杂因素。采用多水平分析比较 PD 和 MF 策略的指标得分，以及这些组之间的差异。使用问卷和 Google Analytics 来评估两种策略的使用情况和经验，以评估可行性。
共有 1326 名幸存者参加了这项研究，其中 673 名参加了前测，653 名参加了后测。关于我们的主要测量指标，我们发现两种策略的 DT 筛查均有显著改善，分别从前测的 34.2%提高到后测的 43.1%（差值=8.9%；优势比（OR）=1.6706；p=0.0072）和从 41.5%提高到后测的 56.1%（差值=14.6%；OR=1.7098；p=0.0028）。对于主要和次要结果，MF 策略与 PD 策略相比，没有观察到统计学上的显著效果。我们发现这两种策略都得到了很好的利用，并获得了积极的经验。
包含增强患者赋权工具的实施策略似乎可有效提高腹盆腔恶性肿瘤幸存者的 DT 系统筛查率。需要进一步研究来评估刺激医疗保健专业人员和医疗保健组织遵守的策略的额外效果。
使用包含增强患者赋权工具的实施策略似乎可以有效提高 DT 筛查率，并可能改善腹盆腔恶性肿瘤幸存者的护理质量。
