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Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: an international survey

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Abstract

Objective

To investigate knowledge, attitudes, and practices of oncologists towards physical activity (PA) in cancer survivors, and the association between oncologists’ own PA behavior and PA promotion.

Methods

Oncologists (n = 123) completed a survey based on the Theory of Planned Behavior (TPB). Participants reported PA promotion behavior, PA involvement, attitudes, intentions, social norm, perceived behavioral control (PBC), and confidence and knowledge of exercise prescription. Structural equation modeling (SEM) evaluated these associations.

Results

Less than half of oncologists reported regularly promoting PA to patients (46%), with 20% providing written information and 23% referrals. Only 26% were physically active. TPB SEM pathways explained 54.6% of the variance in PA promotion (comparative fit index (CFI) = 0.905, standardized root mean square residual (SRMR) = 0.040). Social norm was not only the significant pathway to intention but also a significant indirect pathway to PA promotion (p = 0.007). Confidence to promote PA, PBC, and intentions were direct significant pathways to PA promotion (p < 0.05). Exploratory SEM pathways explained 19.6% of the variance of PA behavior, which in turn explained 13.1% social norm, 10.7% attitude, 10.0% confidence to recommend, and 17.8% PA promotion behavior (CFI = 0.921, SRMR = 0.076). Instrumental attitude was a direct significant pathway to PA behavior (p = 0.001). PA behavior was a direct significant pathway to social norms, attitude, confidence to recommend, and PA promotion (p < 0.05).

Conclusions

Oncologists reported a modest ability to promote PA, low PA promotion rates, and limited knowledge of exercise prescription. Patient physical activity promotion may be improved through strategies that increase oncologists’ PBC, confidence, and their own personal PA participation.

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References

  1. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T (2005) Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol 23:8884–8893

    Article  Google Scholar 

  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  Google Scholar 

  3. Rowland JH (2008) What are cancer survivors telling us? Cancer J 14:361–368

    Article  Google Scholar 

  4. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23:5814–5830

    Article  Google Scholar 

  5. Keats MR, Cui Y, Grandy SA, Parker L (2016) Cardiovascular disease and physical activity in adult cancer survivors: a nested retrospective study from the Atlantic PATH cohort. J Cancer Surviv. https://doi.org/10.1007/s11764-016-0584

  6. Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ et al (2006) Impact of physical activity on cancer recurrence and survival with stage Ш colon cancer. J Clin Oncol 23:3535–3541

    Article  Google Scholar 

  7. Friedenreich CM, Wang Q, Neilson HK, Kopciuk KA, McGregor SE, Courneya KS (2016) Physical activity and survival after prostate cancer. Eur Urol 70:576–585

    Article  Google Scholar 

  8. Deili-Conwright CM, Lee K, Kiwata JL (2016) Reducing the risk of breast cancer recurrence: an evaluation of the effects and mechanisms of diet and exercise. Curr Breast Cancer Rep 8:139–150

    Article  Google Scholar 

  9. Friedenreich CM, Neilson HK, Farris MS, Courneya KS (2016) Physical activity and cancer outcomes: a precision medicine approach. Clin Cancer Res 22:4766–4775

    Article  CAS  Google Scholar 

  10. Hamer J, Warner E (2017) Lifestyle modification for patients with breast cancer to improve prognosis and optimize overall health. CMAJ 189:E268–E274

    Article  Google Scholar 

  11. Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ et al (2008) Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol 17:379–386

    Article  Google Scholar 

  12. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:242–274

    Article  Google Scholar 

  13. Jones LW, Courneya KS, Fairey AS (2004) Effect of an oncologist’s recommendation to exercise on self-reported behavior in newly diagnosed breast cancer survivors: a single-blind randomized trial. Ann Behav Med 29:105–113

    Article  Google Scholar 

  14. Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E (2000) Current health behaviors and readiness to pursue lifestyle changes in men and women diagnosed with early state prostate and breast carcinomas. Cancer 88:674–684

    Article  CAS  Google Scholar 

  15. Hardcastle SJ, Maxwell-Smith C, Hagger MS, O’Connor M, Platell C (2017) Exploration of information and support needs in relation to health concerns, diet and physical activity in colorectal cancer survivors. Eur J Cancer Care 27. https://doi.org/10.1111/ecc.12679

    Article  Google Scholar 

  16. Hardcastle SJ, Tan J, Cohen PA (2017) Factors influencing participation in health behaviours in endometrial cancer survivors. Psycho-Oncology 26:1099–1104

    Article  Google Scholar 

  17. Maxwell-Smith C, Hardcastle SJ, Zeps N, Hagger MS, Platell C (2017) Barriers to physical activity participation in colorectal cancer survivors. Psycho-Oncology 26:808–814

    Article  Google Scholar 

  18. McGowan EL, Speed-Andrews AE, Blanchard CM, Rhodes RE, Courneya KS (2013) Physical activity preferences among a population-based sample of colorectal cancer survivors. Oncol Nurs Forum 40:44–52

    Article  Google Scholar 

  19. Jones LW, Courneya KS, Peddle C, Mackey JR (2005) Oncologists’ opinions towards recommending exercise to patients with cancer: a Canadian National Survey. Support Care Cancer 13:929–937

    Article  Google Scholar 

  20. Nadler M, Bainbride D, Tomasone J, Cheifetz O, Juergens RA, Sussman J (2017) Oncology care providers perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators. Support Care Cancer 25:2297–2304. https://doi.org/10.1007/s005-20-017-3640-9

    Article  PubMed  Google Scholar 

  21. Irwin ML (2009) Physical activity interventions for cancer survivors. Br J Sports Med 43:32–38

    Article  CAS  Google Scholar 

  22. Daley AJ, Bowden SJ, Rea DW (2008) What advice are oncologists and surgeons in the UK giving to breast cancer patients about physical activity? Int J Behav Nutr Phys Act 5:1–4

    Article  Google Scholar 

  23. Spellman C, Craike M, Livingston PM (2014) Knowledge, attitudes and practices of clinicians in promoting physical activity to prostate cancer survivors. Health Educ J 73:566–575

    Article  Google Scholar 

  24. Park J, Oh M, Yoon YJ, Lee CW, Jones LW, Jeon JY (2015) Characteristics of attitudes and recommendations of oncologists toward exercise in South Korea: a cross sectional survey. BMC Cancer 15:249. https://doi.org/10.1186/s12885-015-1250-9

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fisher A, Williams K, Beeken R, Wardle J (2015) Recall of physical activity advice was associated with higher levels of physical activity in colorectal cancer patients. BMJ Open 5(4):e006853. https://doi.org/10.1136/bmjopen-2014-00685

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Karvinen KW, DuBose KD, Carney B, Allison RR (2010) Promotion of physical activity among oncologists in the United States. J Support Oncol 8:35–41

    PubMed  Google Scholar 

  27. Eccles M, Grimshaw J, Walker A, Johnston M, Pitt N (2005) Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol 58:107–112

    Article  Google Scholar 

  28. Godin G, Belanger-Gravel A, Eccles M, Grimshaw J (2008) Healthcare professionals’ intentions and behaviors: a systematic review of studies based on social cognitive theories. Implement Sci 3(1):36

    Article  Google Scholar 

  29. Perkins MB, Jensen PS, Jaccard J et al (2007) Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know? Psychiatr Serv 58(3):342–348

    Article  Google Scholar 

  30. Hardcastle SJ, Maxwell-Smith C, Zeps N, Platell C, O’Connor M, Hagger MS (2017) A qualitative study exploring health perceptions and factors influencing participation in health behaviors in colorectal cancer survivors. Psycho-Oncology 26:199–205

    Article  Google Scholar 

  31. Hardcastle SJ, Maxwell-Smith C, Kamarova S, Lamb S, Millar L, Cohen PA (2018) Factors influencing non-participation in an exercise program and attitudes towards physical activity amongst cancer survivors. Support Care Cancer 26:1289–1295. https://doi.org/10.1007/s00520-017-3952-9

    Article  PubMed  Google Scholar 

  32. Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50:179–211

    Article  Google Scholar 

  33. Corp IBM (2013) IBM SPSS statistics for windows, version 22. IBM Corp, Armonk, p 0

    Google Scholar 

  34. Muthen LK & Muthen BO (2008) MPlus statistical analysis with latent variables user’s guide

  35. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3:77–101

    Article  Google Scholar 

  36. Byrne B (2001) Structural equation modelling with AMOS. Basic concepts, applications and programming. Lawrence Erlbaum Associates, New Jersey

    Google Scholar 

  37. Hu LT, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55

    Article  Google Scholar 

  38. Marsh HW, Hou KT, Wen Z (2004) In search of golden rules: comments on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu & Bentler’s (1999) findings. Struct Equ Model Multidiscip J 11:320–341

    Article  Google Scholar 

  39. Tabachnick BG, Fidell LS (2007) Using multivariate statistics, 5th edn. Allyn & Bacon, New York

    Google Scholar 

  40. Kenny DA, Kaniskan B, McCoach DB (2015) The performance of RMSEA models with small degrees of freedom. Sociol Methods Res 44:486–507

    Article  Google Scholar 

  41. Hawkes A, Chambers S, Pakenham K, Patrao T, Baade P, Lynch BM, Aitken J, Courneya KS (2013) Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol 31:2313–2321

    Article  Google Scholar 

  42. Hardcastle SJ, Cohen PA (2017) Effective physical activity promotion to survivors of cancer is likely to be home based and to require oncologist participation. J Clin Oncol 35:3635–3637

    Article  Google Scholar 

  43. Frank E, Segura C, Shen H, Oberg E (2010) Predictors of Canadian physicians’ prevention counseling practices. Can J Public Health 101:390–395

    PubMed  Google Scholar 

  44. Fie S, Norman IJ, White AE (2013) The relationship between physicians’ and nurses personal physical activity habits and their health-promotion practice: a systematic review. Health Educ J 72:102–119

    Article  Google Scholar 

Download references

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Correspondence to Sarah J. Hardcastle.

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Hardcastle, S.J., Kane, R., Chivers, P. et al. Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: an international survey. Support Care Cancer 26, 3711–3719 (2018). https://doi.org/10.1007/s00520-018-4230-1

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  • DOI: https://doi.org/10.1007/s00520-018-4230-1

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