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Facilitating healthcare practitioners to deliver self-management support in adult cancer survivors: A realist review.

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journal contribution
posted on 2022-07-05, 08:47 authored by Kumud Kantilal, Wendy Hardeman, Hattie Whiteside, Eleni Karapanagiotou, Matthew Small, Debi Bhattacharya

Background

Supporting cancer survivors in self-management can empower them to take an active role in managing the long-term physical and psychosocial consequences of cancer treatment. Healthcare practitioners are key to supporting patients to self-manage, however, they do not routinely engage in these discussions.


This review aimed to establish what works for whom and in what circumstances in relation to facilitating healthcare practitioners to provide self-management support in people living with long-term consequences of cancer treatment.


Methods

The review follows five steps: define the review's scope, develop initial programme theories, evidence search, selection and appraisal, and data extraction and synthesis. Database searches of Medline, EMBASE, CINAHL, Scopus, PsycINFO, ERIC and AMED databases, to September 2019 were supplemented with practitioner surveys. Insights into the mechanisms that operate in particular contexts to produce successful outcomes were illustrated using realist programme theories, developed using the Theoretical Domains Framework. Data selection was based on relevance and rigour. Data were extracted and synthesised iteratively to illuminate causal links between contexts, mechanisms and outcomes.


Results

Five programme theories were identified from 20 included articles and seven practitioner surveys: practitioners will engage patients in discussions about self-management if they have appropriate (1) knowledge and (2) consultations skills, (3) a clear understanding of their self-management support role and responsibilities, and if (4) organisational strategies and (5) health system configuration enable integration into routine care. The mechanisms facilitating practitioners to support self-management were practitioner confidence, mutual trust and shared responsibility between practitioners and cancer survivors, organisational prioritisation and ease of delivery of self-management support.


Conclusion

The findings articulate the necessary components for embedding self-management support into routine cancer care. Operationalisation of these components into effective self-management support interventions will require reconfiguration of pathways and adaptation for local context, using strategies such as quality improvement and co-design to guide intervention development, implementation and evaluation.

Funding

Pharmacy Research UK (PRUK-2018-PA-3-KK)

History

Citation

Research in Social and Administrative Pharmacy, 2022, https://doi.org/10.1016/j.sapharm.2022.05.011

Author affiliation

College of Life Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

Research in social & administrative pharmacy : RSAP

Publisher

Elsevier BV

issn

1551-7411

eissn

1934-8150

Acceptance date

2022-05-20

Copyright date

2022

Available date

2022-07-05

Spatial coverage

United States

Language

eng

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