A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors

Journal Club

11/11/2015

Facilitated by Dr Amanda McCullough

1.  Background

Implementation of effective interventions is important in improving patient care. The best way to implement these interventions to maintain safety and efficacy but also make them acceptable for different contexts is often not known.

2.  Paper presented

    • A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors.
    • Two studies were presented:
      • Breast cancer survivors (with or without lymphedema) attending the National Cancer Institute were invited to participate in an adapted version of an weight lifting intervention (called Strength After Breast Cancer, SABC) to test its safety and effectiveness compared to that in the original trial.
      • Oncology clinicians (physicians and nurses) and physiotherapists from the National Cancer Institute participated in semistructured interviews about the barriers to implementing the SABG programme.
    • Critical appraisal:
      • Recruitment: approximately 1/5 of referred women participated
      • Adherence/attrition: approximately 50% adhered to the intervention, and 20% were lost to follow-up
      • Measurement and blinding: Most of the measures were subjective and did not appear to be collected by blinded assessors. The comparison between the PAL study and SABG study in Table 3 was a useful way of displaying the data.
      • Qualitative assessment (using items from the CASP tool): semi-structured interviews were an appropriate method to explore barriers. More detail on the role of the a priori codes, and how the grounded theory approach had been modified would have been useful. More explanation of how the adaptations in Table 1 were agreed would be helpful. More detail on how clinicians were recruited and the characteristics of these clinicians would allow us to make more inferences about transferability of findings.

3.  Summary of results

The adapted intervention (SABG) appears equally safe and effective as the trial tested in the previous randomised controlled trial. Local barriers to implementation were identified including the referral process, payment and eligibility criteria.

4.  Discussion

The authors have chosen an interesting and useful approach to a diffusion trial. We would have liked more information about why the adaptions were made to the original trial, and how the interviews were analysed, particularly the use of the a priori codes and adapted grounded theory approach to allow this approach to be repeated elsewhere.

5.  Reference

Beidas et al. A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors. Journal of the National Cancer Institute Monographs 2014; 50: 338-345