Embedding multimodal rehabilitation within routine cancer care in Sheffield – The Active Together service evaluation protocol

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Abstract Background Approximately three million people in the UK are currently living with or beyond cancer. People undergoing treatment for cancer, particularly those lacking sufficient physiological reserve, are at risk of complications following treatment. Increasing evidence supports the role of rehabilitation (including prehabilitation) for enhancing psychological and physical wellbeing in cancer patients, reducing the negative impact of treatment side-effects and improving outcomes. Active Together is an evidence-based multi-modal rehabilitation service for patients with a cancer diagnosis, embedded within the cancer care pathway. It provides support to patients, helping them prepare for and recover from treatment. This paper presents the protocol for a pragmatic, real-world evaluation of the Active Together service. The primary aim is to determine the impact of the service on patient outcomes, patient-reported outcomes and clinical endpoints, as well as understand processes that influence its delivery and mechanisms that drive observed outcomes. Methods The Active Together service evaluation adopts a mixed-methods design, comprising an outcome and process evaluation. Combining both an outcome and process evaluation will ensure that data relating to service implementation is integrated into the analysis of outcome measures. The outcome evaluation will use a single group, longitudinal design to determine changes in outcomes of patients that attend the service, and comparative analysis of healthcare resource use against historical patient data. The process evaluation uses service performance indicators, semi-structured interviews and focus groups to explore mechanisms of action and understand contextual factors influencing delivery and outcomes. Integrating measures of psychological change mechanisms with outcome data might help to clarify complex causal pathways within the service. Discussion Evidence to support the role of multi-modal rehabilitation for patients at all stages of their cancer treatment is increasing. The translation of that evidence into practice is less advanced. Findings from this evaluation will contribute to our understanding of the real-world effectiveness of cancer rehabilitation (including prehabilitation) and strengthen the case for widespread uptake and adoption of rehabilitation for people with a cancer diagnosis. Trial registration: This service evaluation was registered with the Clinical Effectiveness Unit at Sheffield Teaching Hospitals (Reference number 11115).

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