Hede, Simone Møller

Larsen, Eva Hjorth

Lemming, Jacqueline Capion

Titel: Ældre kræftoverlevere med senfølger og gruppebaseret fysisk aktivitet - en kvalitativ undersøgelse afoplevede motivationsfaktorer og barrierer.Baggrund: Udviklingen af forbedrede behandlingsmetoder indenfor kræftområdet bevirker, at et størreantal kræftpatienter overlever en kræftsygdom. I 60 % af tilfældene oplever kræftoverlevere imidlertid, atder opstår senfølger, som en konsekvens af den kræftbehandling, som de har modtaget. Senfølger kan væreaf 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. Dereksisterer imidlertid et lavt aktivitetsniveau blandt kræftoverlevere med senfølger, som er særligt udtaltblandt de 65+-årige.Formål: Specialet har til formål at undersøge, hvilke barrierer og motiverende faktorer ældre kræftoverleveremed senfølger oplever ifm. udøvelse af gruppebaseret fysisk aktivitet. Denne viden skal danne grundlagfor udarbejdelsen af et beslutningsgrundlag til en gruppebaseret fysisk aktivitetsintervention til ældrekræftoverlevere med senfølger, mhp. at øge denne målgruppes fysiske aktivitetsniveau.Metode: Specialegruppen har udført en kvalitativ interviewundersøgelse og et litteraturstudie. Interviewundersøgelsebestod af to fokusgruppeinterviews: et med syv informanter fra en selvhjælpsgruppe (gennemsnitsalder=69.7 år), og et med fire informanter fra en motionsintervention (gennemsnitsalder=69.5år). Alle 11 informanter var kvindelige kræftoverlevere med senfølger, som havde haft forskellige kræftsygdomme.Ifm. litteraturstudiet blev følgende databaser afsøgt: PsycInfo, PubMed, Cinahl, Cochrane, SociologicalAbstracts, Embase og Scopus. Ydermere blev Aron Antonovskys teori om Oplevelse af sammenhængog Banduras teori om Self-efficacy, anvendt ift. fortolkningen af empirien.Resultater: Specialet fandt, at ældre kræftoverlevere oplever en indre motivation ifm. deltagelse i fysiskaktivitet grundet de fysiske og psykiske fordele ift. afhjælpning af senfølger. Desuden opleves socialt samværmed ligestillede, som en ydre motivation ift. fysisk aktivitet. Differentiering af fysisk aktivitet oplevesmotiverende ift. deltagelsen heri hos de kræftoverlevere der har høj self-efficacy, og kan bevirke inaktivitethos de, der har en lav self-efficacy. Ydermere oplever kræftoverlevere at smerter, frygt for pådragelse afskader, fysiske senfølger, at føle sig anderledes under træning, tvivl på kroppens fysiske funktion, manglendelyst til at tale om kræftsygdom med andre, manglende præstationsforbedring, samt manglende følelseaf meningsfuldhed ved fysisk aktivitet, kunne udgøre indre barriere for udøvelse af fysisk aktivitet. Deydre barriere, som ældre kræftoverlevere med senfølger kan opleve, ifm. deltagelse i fysisk aktivitet, ermanglende vejledning fra sundhedsvæsnet, manglende social støtte, egenbetaling, følgesygdomme, fuldtidsarbejde,afstand og trafikale forhold. Specialet fandt desuden, at ældre kræftoverlevere kan opleve alvorligepsykiske senfølger, og at psykisk rådgivning fordelagtigt kan afhjælpe dette. De fysiske senfølgeropleves som en negativ social påvirkning. Desuden opleves deltagelse i gruppebaseret fysisk aktivitet fordelagtigifm. at afhjælpe senfølger. Social støtte fra nære relationer opleves vigtigt ifm. deltagelse i fysiskaktivitet. Ydermere blev der fundet en diskrepans ift. at kræftoverleveres omgangskreds kan betragte demsom raske, selvom de selv kan opleve sig syge. Desuden blev det fundet, at ældre kræftoverlevere med senfølgeroplever sig syge ved sammenligning med den generelle befolkning, samt at de ydermere oplever sigselv ældre end de reelt er, grundet deres senfølger.Konklusion: De identificerede barrierer og motivationsfaktorer dannede grundlag for udarbejdelsen afotte anbefalinger. Med afsæt i disse anbefalinger, blev der opstillet et udviklingstiltag til ældre kræftoverleveremed senfølger, som skulle indeholde tre elementer: Gruppebaseret fysisk aktivitet, samtalegrupper ogsocialt samvær. Interventionens kan bidrage til, at øge de ældre kræftoverlevere med senfølgers fysiskeaktivitetsniveau, 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 theperceived motivational factors and barriers.Background: The development of improved cancer treatment options has caused a larger number of cancerpatients to survive their cancer disease. However in 60 % of the cases cancer survivors experience lateeffects, 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-basedphysical activity has shown to be an effective intervention in relation to reducing the late effects. However alow level of physical activity exists among cancer survivors with late effects, which especially is a problemamongst the 65+-year-olds.Aim: The aim of the thesis is to explore which barriers and motivational factors older cancer survivors withlate effects experience in relation to group-based physical activity. This knowledge is used to develop agroup-based physical activity intervention for older cancer survivors with late effects. The aim of the interventionis to increase the physical activity level of this group.Methods: A qualitative study and a literature study were performed. Two focus group interviews wereexecuted 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 (meanage=69.5). All of the participants were older female cancer survivors with late effects, who had had differentcancer diagnoses. The literature study was undertaken in the following databases: PsycInfo, PubMed,Cinahl, Cochrane, Sociological Abstracts, Embase and Scopus. Furthermore Aron Antonovsky’s theory aboutSense of coherence and Albert Bandura’s theory about Self-Efficacy was used in relation to the interpretationof the collected data.Results: The thesis found that older cancer survivors experience inner motivation in relation to physicalactivity caused by the physical and mental benefits in relation to reducing the late effects. Furthermore thesocial companionship with equals was experienced as an outer motivator. The differentiation of the physicalactivity 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 experiencingpain, fear of injuries, physical late effects, feeling different during physical activity, doubt of theirbody’s abilities, not wanting to talk about cancer, lack of performance improvement and not finding physicalactivity meaningful were all inner barriers in relation to physical activity. The outer barriers were lackof guidance from the health professionals, lack of social support, payment, comorbidities, full-time job, distanceand traffic. Furthermore the thesis found that older cancer survivors can experience severe mentallate effects, and that psychological counseling can reduce these. The cancer survivors experience physicallate effects as having a negative social consequence. Furthermore participation in group-based physicalactivity is experienced as advantageously in regards to reducing late effects. Social support from close relativesis experienced as important in relation to participating in physical activity. Moreover a discrepancywas found in relation to how cancer survivors’s social network can think of them as healthy again, eventhough they perceive themselves as still being sick. Furthermore it was found that older cancer survivorswith 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 survivorswith late effects, which can reduce their late effects

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

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