TURNER, Rebecca R. (2020). Developing healthcare professional training to promote exercise in prostate cancer patients. Doctoral, Sheffield Hallam University. [Thesis]
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Turner_2020_PhD_DevelopingHealthcareProfessional.pdf - Accepted Version
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Turner_2020_PhD_DevelopingHealthcareProfessional.pdf - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.
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Abstract
Background
National Institute for Health and Care Excellence (NICE) recommends all men
with prostate cancer undergoing androgen deprivation therapy (ADT) should be
offered a 12-week supervised resistance and aerobic exercise programme,
delivered twice-weekly, to reduce fatigue and improve quality of life. Healthcare
professionals (HCPs) are in a prime position to support delivery of these
recommendations, yet very few do.
Methods
The Medical Research Council (MRC) and Behaviour Change Wheel (BCW)
guidance were used to develop an intervention for HCPs to provide exercise
recommendation, support, and exercise referral for men on ADT. Initially, a
systematic review of interventions to promote exercise behaviour in cancer
survivors and a rapid review of the cancer clinical exercise recommendations
was undertaken. Target behaviours for HCPs were identified from these
reviews. Interview transcripts with thirty-five HCPs were then analysed using the
Theoretical Domains Framework (TDF) to understand barriers to target
behaviours. Intervention functions and behaviour change techniques (BCTs)
were selected and the mode of delivery determined. The intervention was
refined with the input of key stakeholders in the form rehearsal deliveries, focus
groups and a workshop. The training package was delivered and evaluated at
two NHS sites.
Results
From the literature reviews, seven target behaviours were identified to support
the delivery of the NICE recommendations. Key barriers to target behaviours
were identified, these included a perceived lack of time, concerns about patient
capabilities to exercise and lack of awareness of the recommendations. Six
intervention functions and twenty-two BCTs were included in the intervention. A
face-to-face, half-day, interactive and skills-based training-package, with followup at 12-weeks was developed and delivered to seventeen HCPs. Delivery of
all seven target behaviours was evident, although poor adherence to ‘in clinic’
audio-recordings limited fidelity assessment.
Conclusions
A feasible and acceptable training package for HCPs was developed that
resulted in exercise recommendation, exercise support and exercise referral to
men with prostate cancer on ADT. Further evaluation is required to further
assess fidelity of the delivered behaviours.
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