Poster Presentation NSW State Cancer Conference 2023

Physical activity interventions for cancer survivors in Australian general practice: Realist review (#298)

Matthew Patrio MPS Sugiarto 1 , Victoria VJ Jabbour 1 , Kerry KU Uebel 1 , Maria MA Agaliotis 1 2 , Briana BC Clifford 3 4 , Melvin MC Chin 5 , Mark MH Harris 1 , Cristina M. CMC Caperchione 6 , Liz LS Sturgiss 7 , Kylie KV Vuong 1 8
  1. School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
  2. Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
  3. School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
  4. School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
  5. Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  6. School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
  7. School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
  8. School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia

Background: Physical activity (PA) levels among cancer survivors are low. Presently, cancer survivorship care is hospital-led, mainly focusing on cancer surveillance with minimal emphasis on lifestyle improvements. However, with greater general practice involvement in cancer survivorship care, there are opportunities for promoting healthy lifestyle habits, such as increasing PA. Multiple studies have proven that PA improves cancer survivorship and quality of life. This study aims to conduct a realist review to explore the context, mechanism and outcome themes to facilitate increased PA amongst cancer survivors in Australian general practice.

 

Methodology: Articles were obtained from a search of the CINAHL, Embase, PsycINFO, PubMed and SPORTDiscus databases using seven key search terms: “primary care”, “cancer”, “exercise”, “survivorship”, “care plan”, “care coordination” and “coordination of care”. Relevant original studies were identified to develop and test programme theories on the components of PA interventions applicable to the context of Australian metropolitan general practices. This was done to determine what works, for whom does it work and in what circumstances. Regular team meetings were held to identify and further refine our theories on a new subset of studies at each iteration. Data extraction using TIDIeR and subsequent realist synthesis were informed by the themes identified in theory development. The realist synthesis was conducted based on the context(C)-mechanism(M)-outcome(O) framework for realist evaluation. CMO theories were deduced to explain how PA interventions can activate mechanisms within the cancer survivor context to increase PA.

 

Results: From 5679 identified articles, 34 unique studies underwent data extraction and realist synthesis. The finalised programme theory comprised of 6 contextual themes, 9 mechanisms and 5 outcomes. The identified contextual themes were cancer survivor characteristics: (1)cancer stage; (2)symptoms and (3)baseline strength and endurance, and psychological factors: (4)perception towards exercise; (5)baseline motivation and (6)baseline self-efficacy. The elicited mechanisms included behaviour change activities: (1)goals and planning; (2)feedback and monitoring; (3)social support and (4)shaping knowledge, and intervention resources: (5)tailored or general support and (6)self-monitoring tools, and intervention characteristics: (7)repeated and regular intervals; (8)convenient and enjoyable and (9)simple and cost effective. The induced outcomes were strengthened personal capacity: (1)behavioural capability; (2)self-control; (3)outcome expectancies; (4)reinforcement and (5)self-efficacy, ultimately resulting in increased cancer survivor PA.

 

Conclusion: The interactions between various contextual themes and mechanisms produced outcomes based on strengthening personal capacity and ultimately increasing PA. These theories will inform and support the design of cancer survivor PA interventions, sensitive to the practical realities of Australian metropolitan general practice.