Colorectal cancer patients beyond their diseasehindrances, motivation, and positive effects of exercise during chemotherapy treatment

Zusammenfassung

The present doctoral thesis is framed within the research project entitled “Development of an educational and motivational program to promote adherence to physical activity (PA) and its positive effects in colorectal cancer (CRC) patients” with the reference PID2019-107287RA-I00. This dissertation is composed of a set of three main studies: 1) barriers to PA participation in CRC patients during chemotherapy treatment (descriptive study); 2) the concept of hope as a source of motivation regardless of the patients’ thwarted autonomy, competence, relatedness, and novelty during chemotherapy (descriptive study); and 3) positive psychological and behavioral effects of a motivational and educational PA program (FIT-CANCER) based on self-determination theory (SDT) (experimental study). Data obtained for the three articles were collected using qualitative techniques, and all patients were diagnosed with localized CRC (stages II-III) undergoing adjuvant chemotherapy. The current dissertation begins with a systematic review of the factors that promote and hinder PA participation in CRC patients during chemotherapy. This study was published but not included officially along with the rest of the articles due to compliance with the regulations established by the Miguel Hernández University (UMH). However, this study was essential to begin the aforementioned project, allowing us to comprehend prior scientific publications and to design the following research. Study 1 qualitatively explores barriers to PA participation in CRC patients in the middle of adjuvant chemotherapy. Semi-structured interviews were carried out with patients, relatives, and healthcare professionals. Two main themes were identified after data analysis: a) PA barriers related to ostomy and chemotherapy, and b) PA barriers related to the lack of perceived support. Regarding the first theme, we found difficulties associated with ostomy, limitations of the intravenous chemotherapy device (Port-a-Cath), fatigue, associated reduction of physical fitness, focusing on cancer, and restructuring of priorities. Regarding the latter theme, participants referred to the overprotection exerted by relatives, health professionals’ lack of knowledge and time available to prescribe PA, as well as the lack of PA services in health centers. Study 2 qualitatively explores the experiences of basic psychological needs (BPN), motivation to go on living, and psychological well-being in CRC patients during chemotherapy treatment, through two series of semi-structured interviews. Three themes were identified: a) thwarted BPN, b) hope as a source of motivation, and c) sources of hope to foster well-being. Patients reported feeling frustrated autonomy, competence, relatedness, and novelty needs during the chemotherapy. However, they mentioned hopeful thoughts as relevant sources of motivation to live, which had a positive impact on their psychological well-being. The last theme included several subthemes: positive attitude, religious faith, positive medical feedback, knowing that chemotherapy was short-term, and being aware that other patients were in a worse condition. Study 3 qualitatively explores the effects of an educational and motivational PA program (FIT-CANCER) in CRC patients during chemotherapy. This study shows the benefits of applying motivational strategies based on SDT to satisfy patients’ BPN. Two main themes emerged: a) motivational strategies and BPN satisfaction, and b) positive psychological and behavioral consequences. The main subthemes found were: Patients’ feeling safe due to the specialized instructor, the feeling of belonging to a group of people in the same situation, integration of PA in patients’ lifestyle, greater engagement in chemotherapy as well as better management of the side effects, having a good recollection of the treatment period, and the improvement of vitality and well-being.