Building the plane while it’s flying : Implementation lessons from integrating a co-located exercise clinic into oncology care

Journal article

Kennedy, Mary A., Bayes, Sara, Newton, Robert U., Zissiadis, Yvonne, Spry, Nigel A., Taaffe, Dennis R., Hart, Nicolas H. and Galvão, Daniel A.. (2022). Building the plane while it’s flying : Implementation lessons from integrating a co-located exercise clinic into oncology care. BMC Health Services Research. 22, p. Article 1235. https://doi.org/10.1186/s12913-022-08607-w
AuthorsKennedy, Mary A., Bayes, Sara, Newton, Robert U., Zissiadis, Yvonne, Spry, Nigel A., Taaffe, Dennis R., Hart, Nicolas H. and Galvão, Daniel A.
Abstract

Background
Despite its therapeutic role during cancer treatment, exercise is not routinely integrated into care and implementation efforts are largely absent from the literature. The aim of this study was to evaluate a strategy to integrate the workflow of a co-located exercise clinic into routine care within a private oncology setting in two clinics in the metropolitan region of Western Australia.

Methods
This prospective evaluation utilised a mixed methods approach to summarise lessons learned during the implementation of an integrated exercise workflow and supporting implementation plan. Data collection was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Reports detailing utilisation of the exercise service and its referral pathways, as well as patient surveys and meeting minutes documenting the implementation process informed the evaluation.

Results
The co-located exercise service achieved integration into routine care within the clinical oncology setting. Patient utilisation was near capacity (reach) and 100% of clinicians referred to the service during the 13-month evaluation period (adoption). Moreover, ongoing adaptations were made to improve the program (implementation) and workflows were integrated into standard operating practices at the clinic (maintenance). The workflow performed as intended for ~70% of exercise participants (effectiveness); however, gaps were identified in utilisation of the workflow by both patients and clinicians.

Conclusion
Integration of exercise into standard oncology care is possible, but it requires the ongoing commitment of multiple stakeholders across an organisation. The integrated workflow and supporting implementation plan greatly improved utilisation of the co-located exercise service, demonstrating the importance of targeted implementation planning. However, challenges regarding workflow fidelity within and across sites limited its success highlighting the complexities inherent in integrating exercise into clinical oncology care in a real-world setting.

Keywordscancer; physical activity; organizational change; barriers; chemotherapy; radiotherapy
Year2022
JournalBMC Health Services Research
Journal citation22, p. Article 1235
PublisherBioMed Central
ISSN1472-6963
Digital Object Identifier (DOI)https://doi.org/10.1186/s12913-022-08607-w
PubMed ID36203189
Scopus EID2-s2.0-85139371061
PubMed Central IDPMC9535901
Open accessPublished as ‘gold’ (paid) open access
Page range1-12
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online06 Oct 2022
Publication process dates
Accepted26 Sep 2022
Deposited11 Jan 2023
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