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Table 1 Summary of Included Articles

From: Bridging the research to practice gap: a systematic scoping review of implementation of interventions for cancer-related fatigue management

Author, year [Program name], country Study design /Setting/ Sample Size Purpose Participants Models of Care Resources Used/ Described Intervention/ Program Description Implementation Model/ Framework/ Theories
Huether et al., 2016 [36] / Energy Through Motion©]/Iowa United States Pre-, post-test single group/ Ambulatory
/ (n = 39)
Pre-, post-test single group / 2 Survivorship clinics/ (n = 50)
Feasibility (Abbott et al., 2017)
(Huether et al., 2016)
Adult Cancer Survivors Nurse-led survivorship clinics
Home-based exercise
Activity trackers, Resistance Bands, Verbal instruction, Printed material (i.e., exercise & calorie guides), Pedometers, Activity logs, Bottle 3-month physical activity program that incorporated education, a specialised kit (including info on PA benefits, exercise equipment, sleep strategies logbook, home workouts) and ongoing patient support. The program also included an intricate text message system provide information and encouragement and promote adherence. (Cullen & Adams, 2002) Implementation Strategies for Best Practice Guide
EPOC Implementation Strategies
System/health professional level
Reminders: update practice reminders provided by project leader to regularly reinforce the program.
Local Opinion leaders: DNP student, clinical nurse specialist, nurse practitioners informed content and development.
Continuous Quality Improvement: Senior leaders, existing and new team members were regularly updated on intervention progress. Dedicated quality improvement program. Protocol revisions based on feedback from clinicians, patients, or family.
Managerial supervision & Monitoring Performance: Regular reports to senior leaders.
Interprofessional Education & Educational meetings: Presentations on evidence on CRF, physical activity and the Energy Through Motion program at staff meetings, unit in-services, Educational materials: pocket guides provided for clinicians
• Results
° Fatigue: Decreased by an average of 2 points compared to an increase of 0.69 in usual care arm (p = 0.0006)
° Activity Levels: Increased activity levels by a mean of 2.59 points (p = 0.0016) compared to usual care (decreased levels by a mean of 1.07)
° QOL: Improved in all measured areas from 1.24–2.41 points (0–10 scale) compared to decrease (0.69–1.14 points) in usual care.
° Program evaluation: Participants reported that the program was helpful and beneficial. Connecting activity trackers to the computer and follow-along activity videos considered least helpful (Information videos also reported as not used regularly).
• Percent attrition: 10%
Completion rate: 90%
Maintenance (Setting Level)
Program still maintained at the University of Iowa Holden Comprehensive Cancer Centre
Author, year [Program name], country Study design /Setting/ Sample Size Purpose Participants Models of Care Resources Used/ Described Intervention/ Program Description Implementation Model/ Framework/ Theories
Borneman et al., 2011 [34]/ [Passport to Comfort]/
California, United States
Quasi-experimental comparative study/Ambulatory/ (Phase 1 [usual care] n = 83, Phase 2 [intervention] n = 104, Phase 3 [Dissemination] n = 93) Phase 1 &2: Effectiveness
Phase 3: Dissemination
Patients with breast, colon, lung and prostate cancer (at least 1 month after diagnosis). Nurse-led Teaching Packet consisting of written educational materials. Phase 1, 2: Psycho-educational intervention. Each patient received 4 (approx. 60 min) educational sessions as well as written information material or ‘tip’ sheets in a ‘teaching packet’. Tip sheets provided education on exercise, nutrition, emotional issues and sleep disturbance. During sessions, information on pain assessment, fatigue assessment and fatigue management was provided. A month after last educational session participants received bi-weekly follow-up phone calls every 2 weeks for 3 months. None Described
EPOC Implementation Strategies:
System/ Health Professional Level
Local Consensus Processes & Clinical Guidelines: Intervention informed by the National Comprehensive Cancer Network (NCCN). A ‘Patient Pain Knowledge Tool’ was created based on NCCN pain guidelines.
Educational Meetings & Material: Regular meetings with nurses. Pain and fatigue presentations by national experts to oncologists and nurse practitioners. Monthly newsletter to practitioners for ongoing education and communication. Internal Advisory Board met quarterly to gain clinician input from researchers involved in the intervention.
Organisational Culture (Phase 3): Pain and fatigue education provided to all clinicians at a total of 38 in-services. Pain and fatigue information provided at key meetings. Routine fatigue assessment added to outpatient clinic vital sign flow sheet. Increased referrals to supportive care departments for pain and fatigue. Patient education materials were translated into Spanish. Patient education materials made available on employee Intranet. Advocacy posters placed around clinic to remind staff and patients to discuss fatigue.
Audit and feedback: Clinical feedback reports completed for patients and provided to MDs and NPs based on chart audits with specific feedback for pain and fatigue management.
Tailored interventions: Strategies created to address identified patient, professional and system barriers.
Participation rate (Phase 3): 93%
• Phase 1 & 2: Fatigue - fatigue management barriers were significantly higher in the usual care group than in the intervention group. The usual care group had significantly more fatigue (beta = −0.155).
• Phase 3: Fatigue - Significant immediate and sustained effects were shown on the Fatigue Barriers Scale (FBS) for the intervention group. The intervention group demonstrated a significant delayed effect in Physical QOL – maintained baseline levels of QOL throughout the study when we would normally expect a decrease in QOL. Statistically significant differences between QOL measures were small.
Maintenance (Individual)
• (2-month follow-up) Attrition rate: 32.5%
Author, year [Program name], country Study design /Setting/ Sample Size Purpose Participants Models of Care Resources Used/ Described Intervention/ Program Description Implementation Model/ Framework/ Theories
Jones et al., 2020 [33]/ Canada Prospective Cohort/(n = 18) Implementation Intervention
Acceptability and Feasibility
Healthcare professional and community support workers N/A Flipchart/Checklist– summarised guidelines, screening, and assessment information. A one-time in person 2-h training session offered to health care practitioners and community support providers about the CAPO CRF guidelines. First hour provided information on practice gaps reported in literature, CAPO CRF guidelines, communication skills and motivational interviewing principles. Second hour involved role-play and group discussions. Knowledge to Action (KTA) Model
EPOC Implementation Strategies
Clinical Guidelines: Canadian Association of Psychosocial Oncology (CAPO) guidelines for CRF used to inform education sessions.
Local Consensus Processes: Clinical guidelines adapted to the Ottawa context after consensus amongst stakeholders.
Local opinion leaders & Tailored Intervention: Focus interviews and program development with stakeholder groups (patients, health care professionals and community support professionals, pedagogy expert) to identify barriers to change; subsequent strategies then created.
Educational materials: All participants provided with a flipchart that contains information on assessing and managing fatigue.
Participation Rate: 90%
Implementation Impact
• Program was effective in increasing knowledge, self-efficacy and intent to apply guidelines.
CRF Knowledge: −3.959(14), p = 0.001) with a large effect size (d = 0.98).
Self-Efficacy in CRF Assessment (t = 2.621(13), p = 0.021) with a large effect size (d = 0.88).
Self-efficacy to intervene for CRF (t = 2.924(13), p = 0.012) with a large effect size (d = 1.13).
Intent to apply Clinical Guidelines in Practice: t = 4.786(13), p = 0.000) with a large effect size (d = 1.35).
Feasibility: mean satisfaction score (52.27 ± 6.97 out of 60 points maximum).
Completion Rate: 88.9%
Author, year [Program name], country Study design /Setting/ Sample Size Purpose Participants Models of Care Resources Used/ Described Intervention/ Program Description Implementation Model/ Framework/ Theories
Tian et al. 2017 [35]/ China Pre-test, post-test/ Radiotherapy Unit & Medical Oncology Unit/N/A Implementation – Intervention
Translating guidelines into practice
Nursing Staff N/A Nursing record chart,
CRF education booklet,
CRF quality control checklist
Study outlined the creation of a ‘CRF Nursing Guideline’ using a steering group (consisting of clinical experts). The resulting guidelines were implemented into practice through an evidenced-based project utilising training and education for nurses, changes to nursing procedures (screening and assessment and quality review) and the provision of staff resources. Impact of the project was measured at the organisational, staff and patient level. The Promoting Action on Research Implementation in Health Services (PARIHS) framework
EPOC Implementation Strategies:
System/health professional level
Continuous Quality Improvement & Audit and Feedback: Feedback and suggestions periodically collected to determine whether further specific training or modification (to nursing procedure) was required.
Educational materials: CRF Education booklet and other training print materials given to nursing staff.
Educational meetings: Training courses on CRF nursing care were established, including elementary training on evidence-based nursing practice and specific training on CRF nursing care. Seminars on evidence-based practice concerning CRF management.
Clinical Practice Guidelines/ Local Consensus Processes: The “Clinical Practice Guideline: Nursing Care of Cancer-Related Fatigue in Adults with Cancer was developed by interventionists.
Local opinion leaders: Creation of a steering group (six directors from nursing, medical oncology, radiotherapy, Traditional Chinese Medicine, Psychiatry departments. Opinion leader identified to change nurse negative opinion of the project, train other nurses and act as a role model for fellow clinicians. Integration of existing staff into facilitation team.
Tailored Intervention: Initial focus groups and discussions conducted to identify barriers to change. Subsequent strategies then created.
Implementation Impact
• Nurse Outcomes: After implementation of the project, knowledge, attitudes, and behaviour scores were all higher than at baseline.
• Patient Outcomes:
° No differences were detected between the baseline and final scores of the “self-efficacy questionnaire for CRF management” (SQFM) scale.
° Patients adopted more effective CRF management strategies (previously just rested to alleviate fatigue)
° CRF scores lower after intervention than prior to intervention [5.59(2.09) vs. 6.50 (1.90); t = 2.22, p = 0.04].
Author, year [Program name], country Study design /Setting/ Sample Size Purpose Participants Models of Care Resources Used/ Described Intervention/ Program Description Implementation Model/ Framework/ Theories
Van Gerpen & Becker, 2013 [37]/ [LifeSpring]/ United States Program Evaluation Article /Wellness Centre/N/A Program Evaluation Adult Cancer Survivors Physical therapist and exercise physiologist led Resistance Bands
T-shirts w/LifeSpring logo
Written Hand out materials
Balloons (for release at graduation)
Exercise equipment (dumbbells, machines)
Exercise and education program. 12-week program consisting of a bi-weekly exercise session and a weekly education session. Exercise component consists of: 20–30-min of aerobic exercise (5-min intervals of stationary bike, treadmill, walking on the indoor track, recumbent stepper (Nu-SteP), or upper-body ergometer) and 20–30-min of group exercises (resistance training, balance/flexibility/stretching exercises, aquatic exercises and relaxation, Pilates or BODYFLOW™ exercises). Educational sessions are led by content experts and include topics such as exercise and cancer, healing, communication and coping, spirituality sleep. None Described
EPOC Implementation Strategies:
System/Health Professional Level
Local Opinion leaders: Program development by physical therapist, medical and radiation oncologists, general surgeons, nurses, cancer survivors. Phone interviews with intervention leaders from other programs to provide additional insight on recruitment, retention, program design education session topics, screening tools, etc.
Continuous Quality Improvement: Program was modified to include all cancer types (originally only breast cancer survivors) after results from initial program evaluation. Sessions were limited to 12 participants after previous larger class sizes caused challenges in providing individualised support.
Effectiveness/ Efficacy
Participants reported improvements in their fatigue, pain, sleep disturbances, depression, and quality of life, (demonstrated from their pre-, mid-, and post program scores).
• • Fatigue: [5.58 (2.11) vs. 3.55 (1.86); p < 0.0001]
• Sleep [4.77 (2.5) vs. 3.26 (2.27); p < 0.0001],
• Quality of life [3.63 (2.27) vs. 2.08 (1.86); p < 0.0001],
• Pain [2.52 (2.31) vs. 1.85 (1.85); p < 0.001],
• Depression [2.72 (2.21) vs. 1.65 (1.49); p < 0.0001].
Participation/Attendance Rates: 80%. From 2007 to approx. 2013: 182 participated in program and 152 completed the program
Maintenance (Setting Level)
Program still maintained at the Bryan Health Medical Centre
Author, year [Program name], country Study design /Setting/ Sample Size Purpose Participants Models of Care Resources Used/ Described Intervention/ Program Description Implementation Model/ Framework/ Theories
Wang et al., 2018 [32]/ China Clinical Audit/ Hospital/ N/A Implementation Project Nursing Staff N/A Educational materials This article first determined the current state of CRF management in the oncology department by undertaking an initial audit. Strategies (listed below) were then implemented to improve practice and address the barriers identified. A follow-up audit was conducted to evaluate the impact of changes made. None described. Researchers used the JBI Getting Research into Practice (GRiP) tool to identify barriers and practice gaps.
EPOC Implementation Strategies
Local Opinion Leaders: Routine communication with stakeholders to inform strategy development and promote good clinical practice.
Clinical Guidelines: Content of all educational materials derived from the NCCN CRF guidelines.
Organisational Culture & Educational materials: Information brochures and posters about CRF management strategies developed for patients and staff. Flow chart detailing CRF assessment steps created and displayed in nursing unit. Paper-based CRF assessment tools (including BFI) created and distributed for use.
Educational meetings: Formal 2-h education sessions on CRF background, management and assessment delivered to all nurses. ‘Practice fatigue assessments’ and patient education sessions completed by nurses (under supervision).
Monitoring Performance & Managerial Supervision: Ongoing discussions, communication, and monitoring of nurses to ensure compliance.
Tailored interventions: Clinical audit conducted to address barriers to change. Procedures adjusted to account for changes in environment, workload and time restrictions (i.e., reallocation of work tasks, management support, time management via prioritisation of work tasks, balancing resources).
Implementation Impact
Compliance with best practice audit criteria (compliance rates) -
• Health professional received education and training: Baseline audit – 0% Follow up audit - 97%
• CRF assessment upon admission and at regular intervals throughout care: Baseline audit – 0% Follow up audit - 86%
• Focused assessment of fatigue undertaken in patients who screen positively: Baseline audit – 0% Follow up audit - 64%
• Patient education about physical activities: Baseline audit – 3%, Follow up audit - 78%
• Patient informed about the strategies to manage cancer related fatigue: Baseline audit – 0% Follow up audit - 83%
  1. Abbreviations: BFI Brief Fatigue Inventory, CAPO Canadian Association for Psychosocial Oncology, CRF Cancer-related Fatigue, DNP Doctor of Nursing Practice, JBI Joanna Briggs Institute, MD Doctor of Medicine, NCCN National Comprehensive Cancer Network, N/A Not applicable, NP nurse practitioner, PA physical activity, QOL Quality of Life