Cancer-related fatigue guidelines in Australia

Ms Elizabeth Pearson1, Professor Meg Morris2,3, Dr  Carol McKinstry1

1La Trobe University, Bendigo, Australia, 2La Trobe University, Melbourne, Australia, 3Healthscope, Bundoora, Australia

Aim: Cancer-related fatigue (CRF) impacts activities of daily living, causing distress for people living with cancer. Evidence-based guidelines for CRF are available, yet inconsistently implemented. This study aimed to identify barriers and enablers to applying a CRF guideline in Australia and develop implementation strategies.

Method: A mixed-method study explored the feasibility of implementing the Canadian Association for Psychosocial Oncology (CAPO) cancer fatigue guideline. Australian health professionals, managers and consumers with relevant experience of CRF participated in a modified Delphi study with two survey rounds. A reference group contributed to the study design and reviewed questionnaires.

Results: 45 health practitioners and managers, and 68 cancer survivors completed one or two surveys. More than 75% of participants endorsed the CAPO fatigue guidelines. Barriers included a perceived lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation were its complexity, limited practical details for some elements, and lack of assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of professional disciplines in CRF management, (3) to integrate CRF management into policy and practice, (4) ensuring a consumer-focused approach to CRF.

Significance of findings to allied health: Allied health professionals in many settings have key roles in applying CRF guideline recommendations. Implementation may be enhanced by professional education, integration with existing practices, operationalizing and simplifying recommendations, designating roles and access to implementation tools.