Centre for Health Through Physical Activity, Lifestyle and Sports (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, ObservatoryCape Town, 7925, South Africa.
BMC Health Serv Res. 2022 Feb 21;22(1):236. doi: 10.1186/s12913-022-07598-y.
Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations.
Four thousand eight hundred sixty-three unique records identified in Embase, CINAHL, MEDLINE, Web of Science Core Collection, and ProQuest (Health and Medicine) were screened for studies that recruited cancer patients, assessed the co-location of exercise service and cancer treatment units, and reported findings on service implementation. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis.
Service implementation was relatively modest across the included studies. Exercise services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events.
Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise-based rehabilitation for individuals on cancer treatment. While this model appears feasible for patients/clinicians, efforts are required to optimize service integration both in the short and long term. Key priorities include seeking [local] actions to address issues relating to funding and organizational buy-in. Important considerations may include developing an implementation plan to guide the implementation process, expanding the patient core management team to include staff from the exercise rehabilitation unit, and exploring the role of patient feedback in increasing clinician participation (e.g., treating oncologists and nurses) in the referral process. Future research should consider effective strategies to promote patients' sense of self-efficacy and behavioral control and, further, the place of audit and feedback in improving exercise service delivery and overall service implementation.
为了制定可持续的运动肿瘤学临床路径，必须解决将运动服务单位纳入临床肿瘤学环境的可行性问题。我们查阅了现有文献，并提供了实用建议，以支持循证实践、决策制定和进一步研究。
在 Embase、CINAHL、MEDLINE、Web of Science 核心合集和 ProQuest（健康与医学）中筛选出 4863 条独特的记录，这些记录的研究对象均为癌症患者，评估了运动服务与癌症治疗单位的共同定位，并报告了服务实施情况。综合了来自 6 项研究的数据，这些研究的数据来自 30 多个项目。
纳入的研究中，服务实施情况相对较少。运动服务由物理治疗师、运动生理学家和运动学家提供，主要通过赠款和私人捐款资助，员工工资是主要支出。服务渗透率、采用率和接受率普遍较低。然而，研究记录了高临床医生/患者满意度。服务整合的主要障碍是资金有限、缺乏详细的实施计划以及组织认同度低。服务未利用、错过疗程和中途退出的常见原因是缺乏兴趣、身体不适、再次住院、疾病进展和骨骼不良事件。
在临床肿瘤学环境中实施运动服务似乎是增加接受基于运动的康复治疗的个体的有效方法。虽然这种模式对患者/临床医生来说是可行的，但需要努力优化短期和长期的服务整合。优先事项包括寻求[当地]行动，以解决与资金和组织认同度相关的问题。重要的考虑因素可能包括制定实施计划来指导实施过程，扩大患者核心管理团队，纳入运动康复单位的工作人员，以及探索患者反馈在提高临床医生参与（例如，肿瘤医生和护士）转诊过程中的作用。未来的研究应考虑促进患者自我效能感和行为控制的有效策略，并进一步研究审核和反馈在改善运动服务提供和整体服务实施方面的作用。
