The Macmillan Physical Activity Behaviour Change Care Pathway

Problem

Improved cancer survival rates, a growing prevalence of unhealthy lifestyle behaviours, and a growing and ageing population, are contributing to increasing cancer prevalence. By 2040 it is estimated that a total of 5.3 million adults in the United Kingdom will be living with or beyond a cancer diagnosis, representing 6.2 per cent of the male and 8.5 per cent of the female population.

For those who are living longer with and after cancer, they are not necessarily living well. For example, one in four people struggle with the consequences of treatment including heart damage, depression and chronic fatigue. One in two people living with cancer have two or more co-morbidities. Enabling people to be physically active at all stages of their cancer journey can improve both clinical and quality of life outcomes. Despite this, only 23% of people living with cancer are active to recommended levels.

Solution

The Macmillan Physical Activity Behaviour Change Care Pathway comprises five elements:

• raising awareness
• referral
• behaviour change intervention
• physical activity offer, and
• on-going behaviour change support.

The model is based on the NHS adult physical activity care pathway, Let’s Get Moving. It has been tailored for use in a cancer care environment.

Discover and Define

To develop the approach, Macmillan undertook research to understand:

• the impact of physical activity and evidence for bringing about behaviour change for people who have had a cancer diagnosis, other long term conditions and the general population.
• how the promotion of physical activity can be integrated into all stages of cancer care, as part of the recovery package core components.

Key insights:

• A number of methods and frameworks can be used to support individuals changing their behaviour but the key feature throughout all of them is that it they are person centred. The individual should be enabled to progress at their own pace and make decisions.
• People living with and beyond cancer and their family members need to know that it is safe to become and stay active, at a level that is right for them – listening to their body, starting slowly, building gradually, and planning around treatment cycles and physical limitations.
• Messages about taking part in physical activity need to come from trusted healthcare professionals. Messages should be delivered sensitively, with useful examples and information, and people should be signposted on for more support in their local area.
• People living with cancer want to get support from appropriately trained staff and not fear social stigma.
• The terminology used when communicating with people living with cancer about physical activity is important and could affect whether they are engaged or put off. Language could focus on ‘moving more’, ‘increasing everyday activities’ and ‘reducing sedentary time’. Use of the phrase ‘increase physical activity’ could be off‑putting for some people who were not engaged in formal exercise or sports before their diagnosis.

Discover and Deliver

• Local partners across the UK have been invited to apply an overarching model to their local health landscape and population. This has resulted in a number of models, which have been evaluated in a report.
• The programme has grown and evolved since 2010. This work has resulted in a number of models, which have been evaluated in a report.

Timeline

• First test sites were initiated in 2010, additional sites were developed following an awareness raising campaign in 2011.
• In 2013 Macmillan successfully gained match funding from Sport England as part of their Get Healthy, Get Active funding stream. Through this funding, Macmillan worked with six areas across England: Dorset, Berkshire, Luton, Shropshire, Manchester and Sheffield.
• In 2014 Macmillan made physical activity a core priority. A larger number of test sites were developed across the UK by service development teams working with Macmillan’s central specialist physical activity/behaviour change team.
• In 2015 the programme evaluation was expanded and combined with an action learning approach that brought together all of the test sites at regular intervals to share best practice and allow the central Macmillan team to understand what the issues were and co-create solutions. For example, developing a variety of behaviour change interventions to support delivery including a training interventions for health care professionals, direct mail from hospitals to patients. Combined with local innovations such as peer support, league tables of health care referrers.evaluation-of-macmillan-physical-activity-behaviour-change pathway.https://sportengland-production-files.s3.eu-west-2.amazonaws.com/s3fs-public/applying-behaviour-change-theories-real-world-examples-from-ghga.pdf

Read more: Evaluation of Macmillan Integrated Physical Activity Behaviour Change Care Pathway – CFE Research