JL415. Nurses Championing Exercise in Survivorship Care Clinic Visits
Bernadette Labriola, MSN, FNP-C, Duke University, Durham, NC, and Kathy Trotter, DNP, FAANP, Duke School of Nursing, Durham, NC
Objective: Breast cancer survivors are highly motivated to make lifestyle changes that enhance health (Urquhart, 2010). Nurses and nurse practitioners (NPs) often provide cancer survivor care and are in an influential position to educate on the importance of starting or maintaining moderate exercise activities. These may include walking, strength training, aerobic activity, and dance. Specifically, the ONS campaign Get Up and Get Moving campaign supports evidence based practice for oncology nurses to provide individualized activity recommendations to a goal of 100,000 patients in 2016. Nurses can support exercise benefits with encouragement that exercise is a great “medicine” (or therapy?) for the entire mind and body. Physical activity has been shown to improve post cancer treatment related symptoms such as fatigue, muscular strength, aerobic fitness, and quality of life (Baruth, 2013; Hayes, 2013; Schmitz, 2010; Wenzel, 2013; Mayo, 2014). Exercise also decreases the risk of cancer recurrence (Siegel, 2012). Methods: A retrospective chart review (n=25) was accomplished from 1/2015 to 7/2016 in an outpatient breast cancer clinic in a comprehensive cancer center. All chart visits were follow up surveillance visits by a solo NP. Metric 1: Charts were analyzed for an exercise history at each clinic visit with documentation of activity, frequency, and barriers. Metric 2: Charts were analyzed for documentation of patient counseling about an exercise plan with type/frequency/length of time. Results: Metric 1: Documentation of exercise query for 22/25 patients = 78% compliance. Metric 2: Exercise prescription documented for 12/25 patients = 52% compliance. Conclusions: Nurses and nurse practitioners can and do counsel and document exercise levels. Recommendations: More quality assurance research is needed to determine optimum methods of follow up and reinforcement for continued exercise adherence. Implementation of this process could be improved by streamlining history taking during routine visits with the use of a physical activity tool (Godin, 2011) and a standard phrase in the EMR survivor care template. Time constraints in a busy outpatient oncology clinic can be addressed by incorporating the use of assistive personnel distributing the exercise assessment tool, reinforcing teaching and assisting with follow up phone calls. Further, resources to consider may be an exercise physiologist, YMCA Life for Life programs, Institutional walking survivor groups.
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