Implementation of a lifestyle program in primary care among cancer survivors: lessons learned so far

Famke Huizinga, Nico-Derk Lodewijk Westerink, Annette J. Berendsen, Annemiek M. E. Walenkamp, Mathieu H. G. De Greef, Geertruida H. De Bock, Marjolein Y. Berger, Daan Brandenbarg

Keywords: Lifestyle; physical activity; cancer survivors; primary care; implementation

Background:

Lifestyle receives increasing attention in clinical care of chronic diseases. Participation in lifestyle programs is generally low, especially for cancer survivors. They prefer a program that is accessible and close to home. However, there is little evidence on the implementation of lifestyle programs in primary care and the related barriers and facilitators.

Research questions:

To implement and evaluate a physical activity (PA) program for cancer survivors in 15 general practices.

Method:

In this participatory action research we include patients aged ≥18 years who finished cancer treatment ≥6 months ago. The intervention comprises six coaching sessions with the practice nurse (PN) over nine months, seeking to increase PA in daily activities using an activity tracker for goalsetting and feedback. The RE-AIM framework is used to evaluate implementation. Patient measurements include fatigue (FACT-F), depression and anxiety (HADS), weight, number of steps, aerobic endurance (step-test), lower limb strength (sit-to-stand-test), and self-reported PA (IPAQ), at baseline and after 12 weeks.

Results:

Reach: Until now, 82 of 344 invited patients participated in the program (24%). Participants were more often female (p=0.034) and lower educated (p=0.006) than non-participants. Effectiveness: after 12 weeks participants improved on number of steps (p=0.007), the step-test (p<0.001) and IPAQ-vigorous activities (p=0.042), and reduced weight (p=0.041). Many patients highly indicated that the PA program gave them more energy (45%). Frequent perceived barriers of patients were skin irritability of the Fitbit. Adoption: 15 of the 110 invited general practices participated (14%). General practitioners (GPs) and PNs indicated that the PA program is of added value and suits to their daily practice. Barriers of GPs and PNs were a lack of time and personnel.

Conclusions:

These preliminary results show that participants improved PA and aerobic endurance, and rate the program positively. GPs and PNs experience the program as valuable added care.

Points for discussion:

Is primary care (i.e. general practice) suitable for implementation of lifestyle care?

Despite the lack of standardization and a control group, participatory action research provides valuable and even crucial insights for clinical practice

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