Enabling health professionals to provide effective self-management support for cancer-related fatigue

Author: Oluwaseyifunmi Agbejule

Agbejule, Oluwaseyifunmi, 2023 Enabling health professionals to provide effective self-management support for cancer-related fatigue, Flinders University, College of Nursing and Health Sciences

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Background: Cancer-related fatigue (CRF) is one of the most prevalent and distressing symptoms experienced by people diagnosed with cancer. Managing CRF requires individuals to adopt a range of self-management behaviours, thus quality self-management support (SMS) is critical. Clinicians report that a lack of clear guidance on SMS practices hinders their provision of supportive care for CRF. This doctoral thesis focuses on enabling health professionals to support cancer survivors to self-manage their CRF. Specifically, this study contributes to the literature by identifying the core practices required by health professionals to deliver effective SMS to cancer survivors experiencing CRF.

Aims: The aims of this doctoral thesis were to: 1) examine and identify the core components, theories, and effectiveness of self-management interventions in relation to management of CRF for cancer survivors; 2) develop a framework of best practice guidance for SMS in managing CRF in cancer survivors; and 3) gain an understanding of clinical interactions as part of SMS practices in relation to CRF between health professionals and cancer survivors.

Methods: Three studies were conducted. Study 1 was a systematic literature review of randomised controlled trials that examined CRF SMS programs. Study 2 was a modified Delphi study (informed by Study 1) with cancer care clinicians, researchers, and cancer survivors to inform the development of a clinical practice guidance framework for CRF SMS. Study 3 was a conversation analysis of video-/audio-recorded consultations between trained cancer nurse-counsellors and cancer survivors in CRF SMS clinic sessions, to understand how SMS tasks are accomplished in a real-world clinical setting.

Results: In Study 1, 51 papers representing 50 unique studies were identified following a systematic literature search. Synthesis of data illustrated CRF SMS delivered after cancer treatment, facilitated by health professionals, with at least one in-person contact appeared to produce the most favourable fatigue and behavioural outcomes in cancer survivors. Additionally, studies reporting the provision of additional training to intervention facilitators most frequently produced positive intervention effects for CRF and associated behavioural outcomes. Study 2 comprised two modified Delphi study rounds. Fifty-two panel participants in Round 1, and 32 panel participants in Round 2, produced consensus on a clinical practice framework with 44 items (13 Key Practices and 31 Practice Components). Lastly, the investigation of CRF SMS communication in Study 3 indicated that during supportive care sessions, clinicians should focus the conversation on CRF SMS early in the consultation, by clearly introducing the agenda of the consultation from the outset, followed by seeking client agreement. Additionally, Study 3 found that formulating or summarising patient’s talk allows clinicians to maintain a focus on matters relevant for self-management fatigue planning; tie divergent conversation back to support for CRF; and potentially provide supportive care within limited time frames.

Conclusions: The clinical practice framework offers an evidence- and consensus-based model of best practice for health professionals providing SMS for CRF to cancer survivors. Future work is required to identify different stakeholders’ needs in supporting the implementation of the framework in their local settings.

Keywords: cancer-related fatigue, cancer, survivorship, self-management, self-managment support, conversation analysis,

Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Nursing and Health Sciences
Supervisor: Professor Raymond Chan