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. 2022 Oct 6;22(1):1235.
doi: 10.1186/s12913-022-08607-w.

Building the plane while it's flying: implementation lessons from integrating a co-located exercise clinic into oncology care

Mary A Kennedy  1   2 , Sara Bayes  3   4 , Robert U Newton  5   6 , Yvonne Zissiadis  5   7 , Nigel A Spry  5   6   7 , Dennis R Taaffe  5   6 , Nicolas H Hart  5   6   8 , Daniel A Galvão  5   6
Affiliations

Building the plane while it's flying: implementation lessons from integrating a co-located exercise clinic into oncology care

Mary A Kennedy et al. BMC Health Serv Res. .

Abstract

Background: Despite its therapeutic role during cancer treatment, exercise is not routinely integrated into care and implementation efforts are largely absent from the literature. The aim of this study was to evaluate a strategy to integrate the workflow of a co-located exercise clinic into routine care within a private oncology setting in two clinics in the metropolitan region of Western Australia.

Methods: This prospective evaluation utilised a mixed methods approach to summarise lessons learned during the implementation of an integrated exercise workflow and supporting implementation plan. Data collection was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Reports detailing utilisation of the exercise service and its referral pathways, as well as patient surveys and meeting minutes documenting the implementation process informed the evaluation.

Results: The co-located exercise service achieved integration into routine care within the clinical oncology setting. Patient utilisation was near capacity (reach) and 100% of clinicians referred to the service during the 13-month evaluation period (adoption). Moreover, ongoing adaptations were made to improve the program (implementation) and workflows were integrated into standard operating practices at the clinic (maintenance). The workflow performed as intended for ~70% of exercise participants (effectiveness); however, gaps were identified in utilisation of the workflow by both patients and clinicians.

Conclusion: Integration of exercise into standard oncology care is possible, but it requires the ongoing commitment of multiple stakeholders across an organisation. The integrated workflow and supporting implementation plan greatly improved utilisation of the co-located exercise service, demonstrating the importance of targeted implementation planning. However, challenges regarding workflow fidelity within and across sites limited its success highlighting the complexities inherent in integrating exercise into clinical oncology care in a real-world setting.

Keywords: Barriers; Cancer; Chemotherapy; Organizational change; Physical activity; Radiotherapy.

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Conflict of interest statement

All authors have no disclosures to report.

Figures

Fig. 1
Fig. 1
Outline of Implementation Mapping process
Fig. 2
Fig. 2
Integrated workflow for the co-located exercise clinics
Fig. 3
Fig. 3
Reach and capacity of co-located exercise clinics
Fig. 4
Fig. 4
Timeline of implementation adaptations made at the co-located exercise clinics
See this image and copyright information in PMC

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