Background
Compelling evidence from randomised trials shows that exercise positively impacts physical, psychosocial, and disease-related outcomes for cancer survivors [1-6]. Oncology guidance is explicit that we must implement exercise into cancer care. To achieve this, the research team developed PERCS, a triage and referral system which assess patients’ level of exercise need and refers patients to suitable exercise services. PERCS 1.0 (January 2022-October 2023) tested the feasibility of the system, demonstrating high patient acceptability and improvements in physical activity levels.
Aim
The aim of PERCS 2.0 is to develop a cost-effective strategy for national implementation of the PERCS system as a means of advancing integration of exercise into cancer care.
Methods
Work stream 1 aims to estimate the cost effectiveness of PERCS using a model-based simulation. Drawing on best available evidence (i.e., systematic reviews, PERCS 1.0 and evidence emerging in PERCS 2.0), the effectiveness of PERCS in improving QALYs will be estimated. We will gather evidence related to the required resourcing to implement PERCS, the cost (and expected budget impact) of PERCS, including downstream out-of-pocket costs (or subsidies) of exercise programs in the community. Finally, by considering wider healthcare use for cancer patients, reduction in total cost and the incremental cost effectiveness of PERCS will be estimated.
Work stream 2 will develop an implementation strategy for PERCS. Using the Consolidated Framework for Implementation Research (CFIR) we will work with stakeholders from healthcare, community, policy and patients to identify the barriers and facilitators to embedding PERCS. We will identify potentially relevant individual strategies from the ERIC (Expert Recommendations for Implementing Change) taxonomy of implementation strategies to address barriers using the CFIR-ERIC matching tool. Finally, we will work with stakeholders to select the most important strategies, determine what they will look like in our context, and co-design a multi-faceted implementation strategy.