Abstract
Evidence-based practice is a major improvement component of the modern-day healthcare system. Evidence-based practice relies on patient preferences, research findings and expertise to come up with best solutions suited to deliver the care process in the most effective manner. This project seeks to implement physical exercise among patients undergoing cancer treatment as well as those who have successfully undergone cancer therapy to prevent or reduce cancer-related fatigue. A sizeable amount of evidence suggests that physical exercise helps in preventing this form of fatigue and hence enabling this class of patients enjoy a high quality of life. The successful implementation of this evidence bears a lot of significance to nursing care since it helps in the management of underlying conditions such as hypertension and diabetes as well as enabling cancer patients remain independent and enjoy a high quality of life. Dissemination of evidence would rely on formal communication channels within and outside the organization.
PICOT question: In a cancer patient, (P) how does exercise (I) compare to lack of exercise(C) effect patient fatigue level (O) during and after treatment (T)?
Methods: The study utilized semi-structured questionnaires in collecting the relevant data from the participants.
Results: Supervised exercise is more effective and promising in terms of adherence and fatigue-reduction among cancer patients and in all cancer stages.
Conclusion: The development and implementation of exercise programs is an effective intervention that could help in fatigue-reduction among cancer patients and enhance their outcomes and overall wellbeing.
Recommendations: Nurses should Design and implement a nurse-supervised aerobics exercise for cancer patient, Help cancer patients in the development of an exercise program as well as educate them on the best exercise practices and Implement exercise programs which are group-oriented.
Introduction
Evidence-based practice as a concept has evolved to become a major quality and safety improvement component in the modern-day healthcare environment. The beauty of evidence-based practice is that it combines different factors including research, clinical expertise and patient preferences to help in developing best interventions purposed to solve a certain clinical problem. Believably, the 21st century has been associated with increased prevalence of cancer and cancer treatment modalities present patient fatigue as a major challenge. Fatigue related to cancer treatment results to various undesirable patient outcomes which at the end of the day, compromise the quality of life of a cancer patient. As such, guided by the below PICOT question, the purpose of this paper is to present a synthesis of evidence so far gained with regard to dealing with this clinical problem and at the same time, coming with practical evidence-based recommendations that can be implemented in a clinical setting to help in addressing the problem.
PICOT Question: In a cancer patient, (P) how does exercise (I) compare to lack of exercise(C) effect patient fatigue level (O) during and after treatment (T)?
Summary of literature findings
A sizeable amount of credible literature points to physical exercise as an evidence-based intervention to reduce or address fatigue related to cancer, its subsequent treatment and the post-treatment phase. For instance in a quasi-experiment conducted by Yang, Chen and Li (2014) for cancer patients using a case-control approach showed that the intervention group registered reduced fatigue as well as decline in interference from fatigue as compared to the control group. This suggests that exercise is an effective intervention towards arresting fatigue among cancer patients, hence affording them a high quality of life that is devoid of impairments or interferences from fatigue. However, the nature of physical exercise-including intensity and exercise approach appears to be a major consideration when designing a physical exercise program for cancer patients. As Mock et al. (2005) asserts, medium-intensity exercise exhibited an appreciably high level of adherence among cancer patients. As such, there is an implication that a medium-intensity exercise is best suited for this class of patients and most favored. When it comes to administering exercise, especially among adult populations, safety and acceptability are aspects to consider and as Losito, Murphy & Thomas (2006), acknowledges, structured group exercise programs are deemed more acceptable and safe for this class of patients. According to Meneses-Echavez, Gonzalez-Jimenez, & Ramirez-Velez (2015), supervised exercise is more effective and promising in terms of adherence and fatigue-reduction among cancer patients.
Extrapolating from this pool of research evidence, implementing the following evidence-based recommendations within a clinical setting can go a long way in addressing cancer-related fatigue (CRF).
Designing and implementing a nurse-supervised aerobics exercise for cancer patients undergoing treatment and those in the post-treatment phase.
Implementing medium-intensity exercise sessions for cancer patients. Examples of medium-intensity exercise include; water aerobics, ballroom dancing, walking briskly and light jogging.
Helping cancer patients in the development of an exercise program as well as educating them on the best exercise practices
Implementing exercise programs which are group-oriented
Contribution of the evidence-based practice to better outcomes
This evidence is pretty promising in terms of achieving better patient outcomes in different ways. For one, various cancer treatment modalities such as chemotherapy and radiotherapy have fatigue and low levels of energy as a classical side-effect. It thus means that a patient cannot enjoy a normal quality of life due to deprived energy levels. However, this evidence-based practice can viably address these problems, enabling cancer patients to enjoy a normal and high quality of life. Additionally, exercise is quite essential for the optimal management of other conditions such as diabetes, obesity and hypertension. For cancer patients with these pre-existing conditions, exercise can go a long way in helping to manage the conditions and ensuring that cancer-related fatigue do not affect their adherence to the control strategies for these conditions. According to Lambert et al. (2013), depression is significantly high among patients with cancer. In this connection, another contribution of this evidence is that helps in the management of other cancer-related co-morbidities such as depression. In a nut-shell, this evidence bears a lot of contribution with regard to fostering the achievement of desirable outcomes for cancer patients. An advantage of this evidence is that its benefits are multi-dimensional and can be leveraged upon to improve outcomes for cancer patients during and after treatment. Failure to utilize exercise as a modality to reduce cancer related fatigue is associated with various undesirable patient outcomes, including low quality of life, the possibility of developing or exacerbating conditions such as diabetes and hypertension, hence leading to hospital re-admissions as well as increased cost of care.
Dissemination and moving from evidence to practice
Any evidence may be deemed useless if it is not practically implemented within a clinical setting so that its benefits are made visible and tangible. The first step towards moving from just evidence to practice is to share or disseminate the evidence to fellow staff members. As such, the dissemination of this evidence would utilize various communication channels within the organization including sending emails to staff members, providing brochures that breakdown the evidence to fellow colleagues, placing posters at strategic points of the organization within easy access of colleagues as well as utilizing other platforms such as internal seminars and workshops to communicate the evidence. Once the evidence has been communicated to organizational members, the next step would be to educate colleagues on the importance of implementing the evidence and allowing suggestions from colleagues on how to further modify the evidence or make the implementation process more effective. Of course, implementing new evidence in an organizational setting translates to change and changes in routine procedures or organizational culture is seldom accepted. In this regard, there is the need to deal with resistance in order to provide a fertile ground for the evidence to be implemented. This would involve the use of change agents who would comprise of leaders within the organization to persuade colleagues on the need for supporting and implementing the evidence. On the other hand, inculcating a team approach which is founded on democracy would go far in allowing every member’s contribution-something that helps in nurturing organization-wide ownership and acceptance of the evidence.
References
Lambert, S. D., Girgis, A., Lecathelinais, C., & Stacey, F. (2013). Walking a mile in their shoes: anxiety and depression among partners and caregivers of cancer survivors at 6 and 12 months post-diagnosis. Supportive Care in Cancer, 21(1), 75-85.
Losito, J., Murphy, S., & Thomas, M. (2006). The effects of group exercise on fatigue and quality of life during cancer treatment. Oncology Nursing Forum, 33 (4), 821-824.
Meneses-Echavez, J., Gonzalez-Jimenez, E & Ramirez-Velez, R. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: A Systematic and Meta-analysis. BMC Cancer 15(77), 1-13.
Mock, V., Frangakis, C., Davidson, N., Ropka, M., Pickett, M., Poniatowski, B., & McCorkle, R. (2005). Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psycho-Oncology, 14(6), 464-477 14p.
Yang, T., Chen, M & Li, C. (2014). Effects of an aerobic exercise programme on fatigue for patients with breast cancer undergoing radiotherapy. Journal of Clinical Nursing, 24, 202-211.
