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Interventions needed to bridge gap between patient, provider preferences on exercise
Most patients with cancer believe exercise makes them feel better, but only a small percentage indicated their clinical provider instructed them to get physical activity, according to results of a focus group study published in Journal of the National Comprehensive Cancer Network.
Although a majority of physicians think exercise is beneficial for their patients, these providers did not feel knowledgeable enough to make such a recommendation, results showed.
“Our findings highlight the value of examining both patient and provider attitudes when planning an intervention to change behavior,” Agnes Smaradottir, MD, oncologist for Gundersen Health System in Wisconsin, said in a press release. “[Although] we uncovered barriers to exercise recommendations, questions remain on how to bridge the gap between patient and provider preferences.”
Smaradottir spoke with HemOnc Today about the study, as well as what must be done to ensure physicians feel equipped to offer appropriate recommendations to their patients about the benefits of exercise.
Question: What prompted this study?
Answer: Multiple studies have shown that being active has many health benefits for anyone with a chronic illness. These benefits are vast, especially for patients with cancer. We wanted to look at ways to incorporate exercise into the treatment plans in a way that meets the needs of both patients and providers. We felt it was important to hear from our patients about their knowledge of the benefits of exercise, their experience with exercise recommendations from oncology providers, and in what format they would like to receive such recommendations. We also thought we should ask providers what they were doing to promote exercise in their patients.
Q: How did you conduct the study?
A: This focus group study included patients with all stages of cancer — separated into curative and metastatic groups — and all cancer types except breast cancer. Curative patients must have completed treatment within the previous 6 months. Patients with metastatic disease actively received treatment for their disease. The analysis also included providers. We developed a structured question bank and tested it prior to the study. It consisted of two introductory questions, three transition questions, six key questions and a closing question. The same outside facilitator conducted all patient focus groups. Responses were audio taped, transcribed, coded and analyzed.
Q: What did you find?
A: Patients were very interested in physical activity and exercise. They felt that, even though they had incurable cancer, it was important for them to be physically active. In general, patients did not associate exercise or being more active to better outcomes. Some patients heard from their surgeons that they should exercise prior to surgery, but did not recall hearing this from their oncologists. Patients specified they would like to receive recommendations regarding exercise from their oncology provider, who knew what they were going through, and that they wanted home-based programs. Most providers said they would recommend exercise and would prefer to refer patients to an exercise specialist for specific recommendations, because patients often have multiple comorbidities. They also mentioned that, although benefits of exercise have been shown in many patient groups with cancer, the time constraints of clinic visits push recommendations regarding exercise to the wayside.
Q: Did the findings surprise you?
A: We were surprised by how few patients reported being instructed to exercise, and also that patients did not want to be referred to an exercise specialist. Rather, they preferred to get information from their oncologist regarding exercises they should do at home. We were less surprised that oncologists would prefer to have a robust referral system for the patients. A significant gap exists between patients’ and providers’ expectations. We also were surprised that the group with metastatic disease felt that exercise was very important because it made them feel more empowered, and that they would be able to stay active longer if they kept up with some type of exercise.
Q: What is needed to change th e disconnect between patients’ and providers’ expectations ?
A: Oncologists should talk about the importance of exercise as part of the treatment plan for cancer. We need to change a common attitude that if you have cancer, you should stay put and not exert yourself. Both patients and their families need more education about the known benefits of regular exercise. From the provider standpoint, more education about how to incorporate exercise into treatment plans, as well as increased cooperation between oncologists and exercise physiologists in the clinic, could benefit patients and their families. The majority of patients likely would benefit from a general exercise recommendation, whereas a smaller number of patients need more specific assessment of their function and specialized recommendations based on their underlying condition.
Q: What is next for research?
A: We have another study underway in which we will track the activity of two groups of patients via a fitness tracker. One group will receive exercise recommendations from an oncologist at his or her discretion. We will track these patients to measure their endurance and quality of life. A second group will have a combined visit with an exercise physiologist during their oncology visits. The physiologist will help incorporate exercise into each patient’s treatment plan. We then will measure the benefit to the patient. We also will survey clinicians before and after the incorporation of exercise physiologists as to whether they felt it was beneficial.
Q: Would you like to mention anything else?
A: What oncologists say to their patients is very powerful. We have seen this in other areas of cancer care. We have a momentum in terms of trying to change lifestyle, and encouraging patients to be more active can improve outcomes. How we incorporate exercise into the overall treatment plan may differ between institutions. I hope our future research will lead to suggestions about how this might be done in a community-based, multispecialty, health care center. – by Jennifer Southall
Reference:
Smaradottir A, et al. J Natl Compr Canc Netw. 2017;15:588-594.
For more information:
Agnes Smaradottir, MD, can be reached at Center for Cancer and Blood Disorders, Mail Stop EB2-001, Gundersen Health System, 1900 South Ave., La Crosse, WI 54601; email: asmarado@gundersenhealth.org.
Disclosure: Smaradottir reports no relevant financial disclosures.