Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis

Our plain-English summary of Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis, by J. Bayly, D. Wakefield, N. Hepgul, et al (Psycho-oncology, 2018).

The study

• Authors: J. Bayly, D. Wakefield, N. Hepgul, A. Wilcock, I.J. Higginson, M. Maddocks
• Journal: Psycho-oncology
• Published: 2018;27(7):1675-1694
• Type of article: Meta-analysis, Systematic review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: International guidelines recommend that rehabilitation be offered to people with thoracic cancer to improve symptoms, function, and quality of life. When rehabilitation interventions require a change in behaviour, the use of theory and behaviour change techniques (BCTs) enhance participation. Our objective was to systematically identify BCTs and examine their use in relation to the Capability, Opportunity, Motivation-Behaviour model and known enablers and barriers to engagement in this population.

Method: Bibliographic databases and grey literature were searched for controlled trials of rehabilitation interventions for adults with lung cancer or mesothelioma, with no limits on language or date. Data on the application of behavioural change theory and BCTs were extracted, categorised using the BCT Taxonomy (v1) and described according to the "Capability, Opportunity, Motivation-Behaviour" model.

Results: Twenty-seven studies of exercise (n = 15) and symptom self-management (n = 12) interventions were identified. Four studies reported use of behavioural change theory; one study used symptom theory. Across studies, a mean (range) of 7 (1-18) BCTs were used, representing 26 of 93 possible BCTs included in the taxonomy. Most frequent enabling BCTs were "instructions on how to perform behaviours" (74%), "behavioural practice" (74%), and "action planning" (70%). BCTs to address barriers were less frequent and included "information about health consequences" (22%) and "verbal persuasion about capability" (7%) to change perceptions about benefits, burden, and harms.

Conclusion: The application of behavioural change tools appears sub-optimal in this group of patients. Explicit use of BCTs targeting behavioural components upon which outcomes depend may improve the uptake and effectiveness of rehabilitation interventions.

Copyright © 2018 John Wiley & Sons, Ltd.

In plain English

This was a systematic review of earlier studies. The authors searched for controlled trials of rehabilitation for adults with lung cancer or mesothelioma, to February 2017. They coded each intervention's 'behaviour change techniques' against a published list of 93. They included 27 studies with 2,105 participants: 15 exercise studies and 12 symptom self-management studies. Six studies included patients with mesothelioma. Only 5 of the 27 studies (19%) reported a behavioural rationale or theory for the intervention. Studies used a mean of 7 techniques (range 1 to 18), and 26 different techniques overall. The most frequent enabling techniques were instruction on how to perform the behaviour and behavioural practice (each 20 of 27 studies), then action planning (19 of 27); 'credible source' was coded in all studies. Problem-solving techniques appeared in 1 of 15 exercise studies and 6 of 12 symptom studies. Because data were incomplete, the authors could not relate the techniques to uptake or completion. The authors concluded that few such interventions are based on behavioural theory. They noted that techniques were probably used but not reported.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review with narrative synthesis of randomised controlled trials and quasi-experimental studies
• Who was studied: 27 studies with a total of 2,105 participants (17 randomised controlled trials and 10 quasi-experimental studies) of adults with lung cancer or mesothelioma. Patients with mesothelioma were included in six studies. The studies were from Europe, the USA, Australia, Thailand, China, Canada, Hong Kong and Taiwan. The last search was run on 7 February 2017.
• Exposure: Not an asbestos exposure study. The interventions examined were rehabilitation programmes: exercise (15 studies, 761 participants) and symptom self-management (12 studies, 1,344 participants), analysed for their use of behaviour change theory and techniques.
• Main results:
  • Only 5 of the 27 included studies (19%) reported a behavioural rationale or theory behind the intervention design.
  • Across all studies, a mean of 7 behaviour change techniques was used (range 1 to 18).
  • 26 different behaviour change techniques were identified across the studies.
  • The most frequent enabling techniques were instruction on how to perform the behaviour (74%), behavioural practice (74%) and action planning (70%).
  • Instruction on how to perform the behaviour was coded in 20 of 27 studies (74%).
  • Behavioural practice or rehearsal was found in all 15 exercise studies and in 5 of 12 symptom self-management studies (42%), which gives 20 of 27 studies in total.
  • Action planning was found in 19 of 27 studies (70%).
  • The technique 'credible source' was coded in all studies. It was not shown in the figure.
  • Problem-solving techniques were found in 1 of 15 exercise studies (7%) and 6 of 12 symptom self-management studies (50%).
  • The authors could not determine any relationship between the techniques used and uptake or completion of the interventions.
  • In 26 of 27 studies, lack of blinding gave a high risk of performance and detection bias.
• The authors' conclusion: The authors concluded that few rehabilitation interventions studied in patients with thoracic cancer are based on behavioural theory or use behaviour change techniques to optimise participation. They suggested that more comprehensive and standardised use of these techniques may support more acceptable and effective programmes.
• Limitations the authors state:
  • Only explicitly reported techniques were coded, which involved subjective interpretation. The authors addressed this with independent double-coding and discussion.
  • The authors did not contact study authors for protocols and used only those in the public domain.
  • Other techniques were probably used during delivery of the interventions but not reported.
  • Screening and accrual data were incomplete, which prevented analysis of uptake and completion.

Topics

Medical terms in this study, explained in our Lexicon: Systematic Review, Quality of Life, Lung Cancer, Mesothelioma.

Related studies

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• Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service — R. Bentley, A. Hussain, et al. (2013)
• PET scan contribution in chest tumor management: a systematic review for thoracic surgeons — L. Duranti, F. Leo, et al. (2012)
• Factors influencing exercise performance in thoracic cancer — R. England, M. Maddocks, et al. (2012)
• COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study — M.C. Garassino, J.G. Whisenant, et al. (2020)
• Clinical development of TargomiRs, a miRNA mimic-based treatment for patients with recurrent thoracic cancer — G. Reid, S.C. Kao, et al. (2016)

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