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"Now is the time for institutions to be investing in growing exercise programs as part of standard of care" : A multiple case study examining the implementation of exercise oncology interventions
Czosnek, Louise Rankin, Nicole M. Cormie, Prue Murnane, Andrew Turner, Jane Richards, Justin Rosenbaum, Simon Zopf, Eva M.
Czosnek, Louise
Rankin, Nicole M.
Cormie, Prue
Murnane, Andrew
Turner, Jane
Richards, Justin
Rosenbaum, Simon
Zopf, Eva M.
Abstract
Background
Implementation science seeks to systematically identify determinants, strategies, and outcomes within a causal pathway to help explain successful implementation. This process is applied to evidence-based interventions (EBIs) to improve their adoption, implementation, and sustainment. However, this method has not been applied to exercise oncology services, meaning we lack knowledge about implementing exercise EBIs in routine practice. This study aimed to develop causal pathways from the determinants, strategies (including mechanism of change), and implementation outcomes to explain exercise EBIs implementation in routine cancer care.
Methods
A multiple-case study was conducted across three healthcare sites in Australia. Sites selected had implemented exercise within routine care for people diagnosed with cancer and sustained the delivery of services for at least 12 months. Four data sources informed the study: semi-structured interviews with staff, document reviews, observations, and the Program Sustainability Assessment Tool (survey). Framework analysis was applied to understand the findings. The Implementation Research Logic Model was used to identify commonalities in implementation across sites and develop causal pathways.
Results
Two hundred and eighteen data points informed our findings. Across sites, 18 determinants and 22 implementation strategies were consistent. Sixteen determinants and 24 implementation strategies differed across sites and results of implementation outcomes varied. We identified 11 common pathways that when combined, help explain implementation processes. The mechanisms of implementation strategies operating within the pathways included (1) knowledge, (2) skills, (3) secure resources, (4) optimism, and (5) simplified decision-making processes associated with exercise; (6) relationships (social and professional) and support for the workforce; (7) reinforcing positive outcomes; (8) capability to action plan through evaluations and (9) interactive learning; (10) aligned goals between the organisation and the EBI; and (11) consumer-responsiveness.
Conclusion
This study developed causal pathways that explain the how and why of successful implementation of exercise EBIs in cancer care. These findings can support future planning and optimisation activities by creating more opportunities for people with cancer to access evidence-based exercise oncology services.
Implications for cancer survivors
Understanding how to implement exercise within routine cancer care successfully is important so cancer survivors can experience the benefits of exercise.
Keywords
exercise, implementation, cancer, physical activity, evaluation
Date
2023
Type
Journal article
Journal
Supportive Care in Cancer
Book
Volume
31
Issue
7
Page Range
1-20
Article Number
Article 422
ACU Department
Centre for Exercise and Nutrition
Faculty of Health Sciences
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Mary MacKillop Institute for Health Research
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY 4.0
File Access
Open
Notes
© The Author(s) 2023.
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.