Fatigue Management in the oncological rehabilitation (FaM): Development and evaluation of trainings and aftercare modules for the coping of the cancer-related fatigue
- Conditions
- Cancer-related fatigue of patients (ICD10: C50C81-C96C51-C58)G93.3Postviral fatigue syndrome
- Registration Number
- DRKS00008022
- Lead Sponsor
- Verein zur Förderung der Rehabilitationsforschung e.V. Norderney
- Brief Summary
Tumorassociated fatigue is the most common comorbidity of cancer and its therapies. It is associated with physical, psychological and cognitive-mental states of exhaustion of different intensity, which can severely restrict participation in working life and every day life. To cope with the different symptoms and stresses, individually tailored multimodal therapy approaches are essential. The main objective of the FaM study was the development of needs-oriented fatigue management modules for therapy and aftercare for oncological rehab by the rehabilitation team. Further objectives were the process review and the evaluation of the FaM-modules. The qualitative and quantitative data were collected by the participating actors in a method triangulation. The following were carried out: Expert inter-views (a total of 17 participants in individual interviews) with the aim of evaluating the development process and the FaM-module therapy from the perspective of clinic employees and identifying suggestions for improvement. Group interviews before (4 GI with a total of 15 participants) and after (5 GI with a total of 18 participants) the introduction of the FaM module therapy with the aim of obtaining comparative information on the evaluation of fatigue-oriented therapies and identifying changes from the perspective of the rehabilitants. Patient surveys (n=380) before (n=186: control group, KG) and after (n=196: intervention group, IG) introduction of the FaM modules at five measurement points (start of rehab, end of rehab, 1-, 3- and 6-month after discharge) with the aim of obtaining initial information on the effects of the FaM modules (pilot study). Survey of the physicians at home providing further treatment in the intervention group (n=47) with the aim of being able to make statements about the rehab-discharge-report and the rehab aftercare recommendations. The module development strategies have proven their worth, as processes, documents and internal quality checks were considered goal-oriented and sensible by the employees, despite the increased workload. In addition, the continuous work in the expert groups promoted team development and consolidated a cooperative but also appreciative collaboration. This illustrates the importance of the rehab-team for the conception of new therapy offers. Key factors for the successful development and implementation of needs-oriented modules in the rehab team are summarized below: • Agreement on objectives and procedures with the clinic management and transparent and prompt dissemination of information to all rehab staff • Needs analyses with regard to the primary outcomes (target group: rehabilitants) • Current analyzes regarding existing clinic offerings for the primary outcomes (target group: rehab staff) • Ongoing expert group meetings / multi-professional rehab teamwork • Implementation and testing phase including review of process and structural quality (including staff surveys). • Review of the modules in routine care with regard to process-, structure- and outcome- quality (e.g. staff- and patient-surveys). For the FaM module therapy, offers were developed for the areas of sport, occupational therapy, psychology, nutritional advice and a doctor's lecture. This module was successfully implemented into routine care. The content and processes of the FaM module were accepted and positively evaluated by the rehab staff and rehabilitants (IG). Only the differentialdiagnosis of fatigue proved to be problematic according to the rehab-doctors and they would like further support in this regard. As supplementary measures, the rehabilitants requested more intensive psychological care and more individually oriented memory-/concentration training. The results of the group interviews showed that, compared to the control group, the intervention group perceived the rehabilitation to be more fatigue-oriented. By dealing with the issue of fatigue, the intervention group was better able to categorize the symptoms of exhaustion and "fears and feelings of helplessness" were reduced. By being taught fatigue-oriented coping strategies, the intervention group felt better prepared for their return to everyday life than the control group. The handouts and offers of the FaM aftercare module were also consistently rated as positive and practical, as they contained many suggestions for everyday life according to the intervention group. After discharge, the intervention group was able to implement strategies for dealing with their fatigue symptoms with the help of the energy diary by, among other things, organizing their everyday life in a way that conserved their energy, delegating work and learning to say "no". In addition, the majority changed their sports/exercise behavior and dietary habits in line with the rehab recommendations. However, it was not always possible for working participants to plan their day in a way that conserved their energy once they had returned to their workplace with fixed times and break rules. The summative evaluation (pilot study) show-ed significant group differences in favor of the intervention group with regard to general, physical and mental fatigue symptoms (primary target variables) as well as quality of life (secondary target variable) up to the 3-month follow-up, in each case with small to medium effect sizes. There were no intervention effects beyond the 3-month catamnesis. For the continuation of rehab aftercare recommendations, the physicians at home should take on a supporting role. According to the available study results, only a few physicians at home appear to take on such a function - in relation to coping with fatigue. According to three quarters of the IG participants surveyed, the topic of fatigue only played a subordinate role in the doctor-patient discussion up to three months after discharge. Patients with severe fatigue in particular often did not dis-cuss fatigue with their doctor. Furthermore, patients have experienced that their doctor is not fully informed about fatigue or does not want to discuss it, so that the discussions on the subject of fatigue were rated as not very helpful by the patients. As a result, patients would like their doctors to provide further training on the subject of fatigue. However, patients also emphasize that the physicians at home has largely adopted the recommendations from rehab. First and fore-most, they should increase their exercise and sports behavior. The physicians at home providing further treatment (n=47) largely rated the aftercare recommendations from the rehab-discharge-report positively. The majority of doctors considered them to be understandable and practical, but also helpful for discussions with patients and for further treatment. In addition, 90% of doctors consider the aftercare recommendations to be sufficient. However, they should be tailored more to the patient's situation (no standardized text modules) and contain detailed descriptions of the exercises (e.g. in the form of a weekly exercise plan). The physicians at home also expressed the wish to receive more information about fatigue. In a final assessment, three quarters of the doctors providing further treatment rated the rehabilitation as „(very) successful“ for their patients. The following modifications to the FaM modules can be derived from the study results: Development of target group-specific cognitive training units and job-oriented coping strategies for fatigue patients in everyday working life. In addition, educational materials and training courses on the subject of fatigue for doctors in private practice should be developed.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Complete
- Sex
- All
- Target Recruitment
- 380
Patients with a malignant tumor (ICD10: C50; C81-C96; C51-C58), which are tumour treated
(1) Fatigue Screening: Cut-off < 4 (measuring instrument: numeric rating scale NCCN, 2014)
(2) Advanced tumor / palliative situation
(3) Adjuvante chemotherapy and/or radiotherapy is not concluded yet
(4) Insufficient German knowledge
Study & Design
- Study Type
- interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Measuring time: at the beginning, at the end, three and six months after the rehabilitation:<br>multidimensional fatigue inventary (measuring instrument MFI; Smets 1995)<br>
- Secondary Outcome Measures
Name Time Method Measuring time: at the beginning of the rehabilitation, 3 and 6 months after discharge:<br>1. Restriction of social participation (measuring instrument IMET, Deck et al., 2007);<br>2. The functional capability in occupation (measuring instrument IRES-3; Bührlen et al. 2005);<br>3. Quality of life (measuring instrument EORTC-QLQ-C30: Aaronson et al. 1993)<br>