Ældre kræftoverlevere med senfølger og gruppebaseret fysisk aktivitet - en kvalitativ undersøgelse af oplevede motivationsfaktorer og barrierer

Abstract

Titel: Ældre kræftoverlevere med senfølger og gruppebaseret fysisk aktivitet - en kvalitativ undersøgelse af oplevede motivationsfaktorer og barrierer. Baggrund: Udviklingen af forbedrede behandlingsmetoder indenfor kræftområdet bevirker, at et større antal kræftpatienter overlever en kræftsygdom. I 60 % af tilfældene oplever kræftoverlevere imidlertid, at der opstår senfølger, som en konsekvens af den kræftbehandling, som de har modtaget. Senfølger kan være af hhv. fysisk, psykisk og social karakter, og kan have en negativ påvirkning på kræftoverleverens livskvalitet. Gruppebaseret fysisk aktivitet har vist sig, som en effektiv intervention ift. afhjælpning af senfølger. Der eksisterer imidlertid et lavt aktivitetsniveau blandt kræftoverlevere med senfølger, som er særligt udtalt blandt de 65+-årige. Formål: Specialet har til formål at undersøge, hvilke barrierer og motiverende faktorer ældre kræftoverlevere med senfølger oplever ifm. udøvelse af gruppebaseret fysisk aktivitet. Denne viden skal danne grundlag for udarbejdelsen af et beslutningsgrundlag til en gruppebaseret fysisk aktivitetsintervention til ældre kræftoverlevere med senfølger, mhp. at øge denne målgruppes fysiske aktivitetsniveau. Metode: Specialegruppen har udført en kvalitativ interviewundersøgelse og et litteraturstudie. Interviewundersøgelse bestod af to fokusgruppeinterviews: et med syv informanter fra en selvhjælpsgruppe (gennemsnitsalder= 69.7 år), og et med fire informanter fra en motionsintervention (gennemsnitsalder=69.5 år). Alle 11 informanter var kvindelige kræftoverlevere med senfølger, som havde haft forskellige kræftsygdomme. Ifm. litteraturstudiet blev følgende databaser afsøgt: PsycInfo, PubMed, Cinahl, Cochrane, Sociological Abstracts, Embase og Scopus. Ydermere blev Aron Antonovskys teori om Oplevelse af sammenhæng og Banduras teori om Self-efficacy, anvendt ift. fortolkningen af empirien. Resultater: Specialet fandt, at ældre kræftoverlevere oplever en indre motivation ifm. deltagelse i fysisk aktivitet grundet de fysiske og psykiske fordele ift. afhjælpning af senfølger. Desuden opleves socialt samvær med ligestillede, som en ydre motivation ift. fysisk aktivitet. Differentiering af fysisk aktivitet opleves motiverende ift. deltagelsen heri hos de kræftoverlevere der har høj self-efficacy, og kan bevirke inaktivitet hos de, der har en lav self-efficacy. Ydermere oplever kræftoverlevere at smerter, frygt for pådragelse af skader, fysiske senfølger, at føle sig anderledes under træning, tvivl på kroppens fysiske funktion, manglende lyst til at tale om kræftsygdom med andre, manglende præstationsforbedring, samt manglende følelse af meningsfuldhed ved fysisk aktivitet, kunne udgøre indre barriere for udøvelse af fysisk aktivitet. De ydre barriere, som ældre kræftoverlevere med senfølger kan opleve, ifm. deltagelse i fysisk aktivitet, er manglende vejledning fra sundhedsvæsnet, manglende social støtte, egenbetaling, følgesygdomme, fuldtidsarbejde, afstand og trafikale forhold. Specialet fandt desuden, at ældre kræftoverlevere kan opleve alvorlige psykiske senfølger, og at psykisk rådgivning fordelagtigt kan afhjælpe dette. De fysiske senfølger opleves som en negativ social påvirkning. Desuden opleves deltagelse i gruppebaseret fysisk aktivitet fordelagtig ifm. at afhjælpe senfølger. Social støtte fra nære relationer opleves vigtigt ifm. deltagelse i fysisk aktivitet. Ydermere blev der fundet en diskrepans ift. at kræftoverleveres omgangskreds kan betragte dem som raske, selvom de selv kan opleve sig syge. Desuden blev det fundet, at ældre kræftoverlevere med senfølger oplever sig syge ved sammenligning med den generelle befolkning, samt at de ydermere oplever sig selv ældre end de reelt er, grundet deres senfølger. Konklusion: De identificerede barrierer og motivationsfaktorer dannede grundlag for udarbejdelsen af otte anbefalinger. Med afsæt i disse anbefalinger, blev der opstillet et udviklingstiltag til ældre kræftoverlevere med senfølger, som skulle indeholde tre elementer: Gruppebaseret fysisk aktivitet, samtalegrupper og socialt samvær. Interventionens kan bidrage til, at øge de ældre kræftoverlevere med senfølgers fysiske aktivitetsniveau, således at denne målgruppe kan få mindsket deres senfølger.

Title: Older cancer survivors with late effects and group-based physical activity – a qualitative study of the perceived motivational factors and barriers. Background: The development of improved cancer treatment options has caused a larger number of cancer patients to survive their cancer disease. However in 60 % of the cases cancer survivors experience late effects, as a consequence of the cancer treatment they have received. The late effects can be of physical, mental and/or social character, and can affect the cancer survivor’s quality of life negatively. Group-based physical activity has shown to be an effective intervention in relation to reducing the late effects. However a low level of physical activity exists among cancer survivors with late effects, which especially is a problem amongst the 65+-year-olds. Aim: The aim of the thesis is to explore which barriers and motivational factors older cancer survivors with late effects experience in relation to group-based physical activity. This knowledge is used to develop a group-based physical activity intervention for older cancer survivors with late effects. The aim of the intervention is to increase the physical activity level of this group. Methods: A qualitative study and a literature study were performed. Two focus group interviews were executed in relation to the qualitative study: An interview with seven participants from a self-help-group (mean age = 69.7), and an interview with seven participants from a physical activity intervention (mean age=69.5). All of the participants were older female cancer survivors with late effects, who had had different cancer diagnoses. The literature study was undertaken in the following databases: PsycInfo, PubMed, Cinahl, Cochrane, Sociological Abstracts, Embase and Scopus. Furthermore Aron Antonovsky’s theory about Sense of coherence and Albert Bandura’s theory about Self-Efficacy was used in relation to the interpretation of the collected data. Results: The thesis found that older cancer survivors experience inner motivation in relation to physical activity caused by the physical and mental benefits in relation to reducing the late effects. Furthermore the social companionship with equals was experienced as an outer motivator. The differentiation of the physical activity was experienced as a motivator in regards to the cancer survivors who had a high level of selfefficacy, and can cause inactivity for cancer survivors with low levels of self-efficacy. Furthermore experiencing pain, fear of injuries, physical late effects, feeling different during physical activity, doubt of their body’s abilities, not wanting to talk about cancer, lack of performance improvement and not finding physical activity meaningful were all inner barriers in relation to physical activity. The outer barriers were lack of guidance from the health professionals, lack of social support, payment, comorbidities, full-time job, distance and traffic. Furthermore the thesis found that older cancer survivors can experience severe mental late effects, and that psychological counseling can reduce these. The cancer survivors experience physical late effects as having a negative social consequence. Furthermore participation in group-based physical activity is experienced as advantageously in regards to reducing late effects. Social support from close relatives is experienced as important in relation to participating in physical activity. Moreover a discrepancy was found in relation to how cancer survivors’s social network can think of them as healthy again, even though they perceive themselves as still being sick. Furthermore it was found that older cancer survivors with late effects can perceive themselves as sick when they compare themselves to the general population, and that they can perceive themselves as older than they are because of the late effects. Conclusion: The identified barriers and motivational factors were used to establish eight recommendations. From these recommendations an intervention for older cancer survivors with late effects were constructed, which consisted of three elements: group-based physical activity, discussion groups and socialiazing. The intervention can contribute to enhancing the physical activity level of older cancer survivors with late effects, which can reduce their late effects.

A master thesis from Aalborg University

Ældre kræftoverlevere med senfølger og gruppebaseret fysisk aktivitet - en kvalitativ undersøgelse af oplevede motivationsfaktorer og barrierer

[Older cancer survivors with late effects and group-based physical activity – a qualitative study of the perceived motivational factors and barriers]