Effectiveness of an integrated experiential training program with coaching by nursing students in promoting physical activity and reducing fatigue among Hong Kong Chinese childhood cancer patients

Abstract

Background. Despite advances in cancer screening technology and treatment in recent years, children with cancer still persistently suffer from physical and psychological issues throughout their cancer treatment and survivorship, consequently affecting their quality of life (QoL). Cancer-related fatigue is the most commonly reported symptom among children with cancer and its effect is long-lasting, remaining for years after treatment. Strong evidence of the role of physical activity in reducing cancer-related fatigue indicates the importance of introducing exercise interventions to children with cancer following diagnosis. However, the level of physical activity in children with cancer tends to decline over time, which demonstrates the ineffectiveness of the existing exercise interventions in changing children’s behaviour. Experiential learning and coaching have been found to be effective methods in altering children’s behaviour. Nevertheless, it remains unclear whether the application of these two strategies by nursing students can change the exercise behaviour of children with cancer to reduce their fatigue. Rigorous empirical scrutiny of the effectiveness of such an integrated programme warrants immediate attention.

Aim.To investigate the effectiveness of an integrated experiential training programme, with coaching by nursing students, in promoting physical activity, reducing fatigue and enhancing QoL among Hong Kong Chinese children receiving cancer treatment.

Methods. Before the interventional study, the physical activity levels and factors contributing to physical inactivity in Hong Kong Chinese children with cancer were explored. A pilot randomised controlled trial (RCT) was first conducted, followed by a major RCT with a total of 70 Hong Kong Chinese children who were 9 to 18 years of age and receiving cancer treatment in a local public acute hospital. Among the 70 participants, 37 were randomly assigned to the experimental group to engage in the integrated programme, with 28 home visits within a 6-month period. Thirty-three participants were assigned to the placebo control group to receive the placebo intervention. Both groups were required to assess theircancer-related fatigue, physical activity levels, self-efficacy, depressive symptoms, hand grip strength and QoL at baseline, 6 and 9 months after starting the intervention.

Results. Statistically significantly lower levels of cancer-related fatigue and depressive symptoms, higher levels of physical activity and self-efficacy, greater right- and left-hand grip strength and better QoL were reported in participants in the experimental group than those in the placebo control group at 9 months after starting the intervention.

Conclusion. This is the first RCT investigating the effectiveness of an integrated experiential training programme, with coaching by nursing students, in children with cancer. The results indicate that such a programme is effective in reducing fatigue and promoting physical activity and QoL among Hong Kong Chinese children receiving cancer treatment.

Implications for practice. The findings provide further evidence that regular physical activity is of paramount importance for children with cancer. In particular, this study demonstrates the effectiveness and feasibility of incorporating experiential training through coaching in promoting regular physical activity, reducing fatigue and improving QoL among children with cancer, which has important implications for clinical practice.