Developing healthcare professional training to promote exercise in prostate cancer patients

Background National Institute for Health and Care Excellence (NICE) recommends all men with prostate cancer undergoing androgen deprivation therapy (ADT) should be offered a 12-week supervised resistance and aerobic exercise programme, delivered twice-weekly, to reduce fatigue and improve quality of life. Healthcare professionals (HCPs) are in a prime position to support delivery of these recommendations, yet very few do. Methods The Medical Research Council (MRC) and Behaviour Change Wheel (BCW) guidance were used to develop an intervention for HCPs to provide exercise recommendation, support, and exercise referral for men on ADT. Initially, a systematic review of interventions to promote exercise behaviour in cancer survivors and a rapid review of the cancer clinical exercise recommendations was undertaken. Target behaviours for HCPs were identified from these reviews. Interview transcripts with thirty-five HCPs were then analysed using the Theoretical Domains Framework (TDF) to understand barriers to target behaviours. Intervention functions and behaviour change techniques (BCTs) were selected and the mode of delivery determined. The intervention was refined with the input of key stakeholders in the form rehearsal deliveries, focus groups and a workshop. The training package was delivered and evaluated at two NHS sites. Results From the literature reviews, seven target behaviours were identified to support the delivery of the NICE recommendations. Key barriers to target behaviours were identified, these included a perceived lack of time, concerns about patient capabilities to exercise and lack of awareness of the recommendations. Six intervention functions and twenty-two BCTs were included in the intervention. A face-to-face, half-day, interactive and skills-based training-package, with followup at 12-weeks was developed and delivered to seventeen HCPs. Delivery of all seven target behaviours was evident, although poor adherence to ‘in clinic’ audio-recordings limited fidelity assessment. Conclusions A feasible and acceptable training package for HCPs was developed that resulted in exercise recommendation, exercise support and exercise referral to men with prostate cancer on ADT. Further evaluation is required to further assess fidelity of the delivered behaviours.