Cancer related fatigue: implementing guidelines for optimal management.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Cancer-related fatigue: appraising evidence-based guidelines for screening, assessment and management.

PURPOSE: There is inconsistent management of cancer-related fatigue (CRF) by health professionals worldwide. This research aims to identify the most appropriate guidelines for the management of cancer-related fatigue. METHODS: A systematic search of international literature identified evidence-based clinical practice guidelines for CRF. Four reviewers independently appraised the highest quality guidelines using the AGREE-II instrument and National Heath and Medical Research Council (NHMRC) guideline standards. RESULTS: Five guidelines met the inclusion criteria. Of these, the 2015 Canadian Association of Psychosocial Oncology (CAPO) CRF guidelines and the 2014 American Society of Clinical Oncology (ASCO) fatigue guidelines for cancer survivors were selected for in-depth appraisal. The CAPO guideline scored higher than the ASCO for five domains of the AGREE-II. For one domain, the differences were statistically significant (p ≤ 0.05). The CAPO guideline met 37 of 47 NHMRC mandatory guideline standards and the ASCO guideline met 20. The difference in the proportion of standards met was statistically significant for one domain (p ≤ 0.05). Both guidelines had low scores for applicability and implementation. CONCLUSIONS: Currently, the CAPO guideline for cancer-related fatigue has the strongest evidence for use. To enhance implementation, further strategies for guideline dissemination and application are needed.

Cancer-related fatigue: a survey of health practitioner knowledge and practice.

PURPOSE: This study aims to identify the current practices of health professionals in the assessment and treatment of cancer-related fatigue (CRF). METHODS: Health professionals working with oncology clients participated in an electronic survey distributed via professional associations and oncology societies. RESULTS: One hundred twenty-nine professionals from nursing, medical, and allied health disciplines participated in an electronic survey. Overall, there was a perception that CRF was inadequately managed at some facilities. Routine fatigue screening processes in the workplace were reported by more than half of participants; however, less than one quarter used a clinical guideline or conducted in-depth CRF assessments. Awareness of interventions for CRF varied amongst participants with one quarter able to list five appropriate interventions for cancer-related fatigue. Access to services for managing fatigue was inconsistent across service types, with post-treatment triage a high priority for CRF in some organisations yet not others. Participants identified a need for improved guidelines, enhanced expertise and better access to services for people with CRF. CONCLUSIONS: There is a need for further education in CRF management for a range of health disciplines in oncology and additional resources to facilitate translation of CRF guidelines into clinical practice.

Oncology staff reflections about a 52-year-old staff Christmas choir: constructivist research.

OBJECTIVE: Peter MacCallum Cancer Centre has one of the world's most enduring staff Christmas choirs. Commencing in 1956, the choir performs in a cafeteria, patient wards, and outpatient waiting areas before each Christmas. With recent emphasis on oncology staff support needs the choir's relevance warranted investigation. This constructivist research examined what effect the staff Christmas choir had on the choir members and staff bystanders in 2008. METHODS: Sampling was convenience and purposive. Staff choir members were invited to participate during rehearsals, and staff bystanders were invited at seven choir performances in the hospital. Respondents completed anonymous and semistructured questionnaires and the conductor (of 29 years) was interviewed. The inductive, comparative, and cyclic data analyses were informed by grounded theory and qualitative interrater reliability was performed. RESULTS: Questionnaires from 64 staff were returned. The choir elicited positive emotions, memories, Christmas spirit, hospital community and/or work-life effects for many staff, in a cancer context described as sometimes "overwhelming" and "stressful." Choir members' reactions included stress relief, friendship and feeling rewarded. Bystanders' reactions included feeling uplifted, inspired and moved. Suggestions for future performances were offered, including musical acknowledgement of other religious festivals. Two respondents were concerned about intrusive effects on patients and work practices. DISCUSSION: A staff Christmas choir supported most choir member and staff bystander respondents in an oncology hospital and is recommended in comparable contexts. Further investigation is warranted to extend understanding about Christmas music's effects in palliative care settings.

How can occupational therapists measure outcomes in palliative care?

The objective of this paper is to identify an outcome measure for occupational therapy interventions with palliative clients, in particular Home Assessments. Several possibilities beyond traditional functional measures are considered, and the notion of quality of life (QoL) as a potential measure and routine part of assessment is discussed.A systematic literature search resulted in 45 QoL tools that might be suitable for palliative care. The validation or development papers for these tools were closely examined. Twenty-four instruments met the inclusion criteria for further consideration for use by occupational therapists. The research found that it may be feasible for occupational therapists to use a QoL tool as a routine part of assessing each palliative patient, with the objective of focusing interventions to priority areas identified by the patient. Further work in this area will identify a range of established and validated methods of assessing QoL, suitable for different stages within the palliative phase of illness for purposes including assessment, support and targeted interventions.