Rutkowski, Nicole Anna2025-06-272025-06-272025-06-27http://hdl.handle.net/10393/50599https://doi.org/10.20381/ruor-31201Cancer related fatigue (CrF) is one of the most prevalent and debilitating post treatment side effects and has been reported as an long-standing unmet need for individuals living beyond cancer (Roseleur et al., 2023). CrF has been defined as a “distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning” (Berger, et al., 2015). Approximately a third of cancer survivors will continue to experience moderate to severe fatigue for several years post treatment (Al Maqbali et al., 2021; Kang et al., 2023). Persistent fatigue has been found to have significant adverse impacts on quality of life and contribute to high levels of disability (Jones et al., 2016). Given the prominence of CrF, guidelines for the assessment and management of CrF have been developed. In Canada, evidence-based guidelines by the Canadian Association for Psychosocial Oncology (CAPO) are available (Howell et al., 2015). Internationally, evidence-based guidelines are available from several international organizations, including European Society for Medical Oncology (ESMO) (Fabi et al., 2020), National Comprehensive Cancer Network (NCCN), (Berger et al., 2015) and most recently the American Society of Clinical Oncology (ASCO) (Bower et al., 2024). Guidelines suggest a variety of effective nonpharmacological interventions for the management of CrF including cognitive behavioural therapy, psychoeducation, mind-body interventions, and physical activity (Howell et al., 2015). Despite the availability of guidelines for CrF and well researched interventions that have demonstrated effectiveness implementation has been lacking (Pearson et al., 2017). Several barriers have been identified including lack of healthcare provider training and knowledge, a lack of leadership, attitudes of patients and HCP towards CrF including perceptions of treatment futility, complexity of guidelines, and inefficient referral pathways (Jones et al., 2021; Pearson et al., 2023; Thong, van Noorden, et al., 2020). This thesis’ objectives were to adapt, implement, and evaluate an intervention for CrF in a community context using the Knowledge-to-Action framework (KTA) (Field et al., 2014), RE-AIM framework (Holtrop et al., 2021), and community and patient partnership. Study 1 captures KTA stages of adaptation of knowledge to the local context and identification of barriers by exploring what an ideal intervention for CrF would look like from the perspectives of different interest holders and the barriers to its implementation. A total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs) were recruited. This needs assessment described what patients, CSPs, and HCPs wanted in an ideal intervention for CrF and the potential barriers to implementing such intervention through qualitative methodology. Data was collected via nine focus groups and four semi-structured interviews. Data was coded into themes using content analysis. Two main themes emerged around addressing CrF: “It takes a village” and “This will not be easy”. Participants discussed an intervention for CrF could be anywhere, offered by anyone and everyone, and provided early and frequently throughout the cancer experience and could include peer support, psychoeducation, physical activity, mind–body interventions, and interdisciplinary care. Patients, HCPs, and CSPs described several potential barriers to implementation, including patient barriers (i.e., patient variability, accessibility, online literacy, and overload of information) and systems barriers (i.e., costs, lack of HCP knowledge, system insufficiency, and time). This study laid the groundwork for study 2’s implementation of a patient-centered intervention for CrF in a community context by identifying a significant need for CrF programming in the local context, guiding the selection of an intervention, and preparing for anticipated barriers. Study 2 addresses KTA stages of selection/tailoring of an intervention, monitoring knowledge use, evaluating outcomes, and sustaining knowledge use. Based on our needs assessment, an evident knowledge to practice gap exists for CrF management in Ottawa, Canada. This pilot study employed a type-2 hybrid effectiveness-implementation design. Participants (N=50) were randomized to either an intervention group or a wait-list control, with both groups completing questionnaires at baseline, at 5 weeks, and at 2-month follow-up. Participants assigned to the intervention group received four virtual 90-minute sessions facilitated by a registered nurse/cancer coach. The CrF intervention showed promise of improvements in quality-of-life improvements on the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F-13) (F2,84=4.73, p= .015, ηp2 = .101) and reduced fatigue on the Multidimensional Fatigue Inventory-20 (MFI-20) (F2,84=6.18, p= .007, ηp2 = .128), compared to the wait-list control. Improvements in sleep and depression were also found. Evaluation of implementation outcomes were guided by the RE-AIM framework (Holtrop et al., 2021). The intervention was delivered with high levels of fidelity and low attrition. The intervention was found to be feasible with high satisfaction rates suggesting acceptability. Through partnership with a community organization and patient advisory board, this project was able to ensure a) end users and providers’ needs were met and b) maintenance of the CrF program for individuals living with and beyond cancer who are experiencing CrF in the Ottawa region.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/cancer survivorshippsychosocial oncologyfatigueimplementation sciencehybrid effectiveness-implementation designThesis