Tailoring of exercise and dietary interventions to adverse effects and existing comorbidities in patients with ovarian cancer receiving chemotherapy: a clinical vignettes study among expert physical therapists and dietitians.

Abstract

This study aims to capture the complex clinical reasoning process during tailoring of exercise and dietary interventions to adverse effects and comorbidities of patients with ovarian cancer receiving chemotherapy. Clinical vignettes were presented to expert physical therapists (<i>n</i> = 4) and dietitians (<i>n</i> = 3). Using the think aloud method, these experts were asked to verbalize their clinical reasoning on how they would tailor the intervention to adverse effects of ovarian cancer and its treatment and comorbidities. Clinical reasoning steps were categorized in <i>questions</i> raised to obtain additional information; anticipated <i>answers</i>; and <i>actions</i> to be taken. Questions and actions were labeled according to the evidence-based practice model. <i>Questions</i> to obtain additional information were frequently related to the patients' capacities, safety or the etiology of health issues. Various hypothetical <i>answers</i> were proposed which led to different actions. Suggested <i>actions</i> by the experts included extensive monitoring of symptoms and parameters, specific adaptations to the exercise protocol and dietary-related patient education. Our study obtained insight into the complex process of clinical reasoning, in which a variety of patient-related variables are used to tailor interventions. This insight can be useful for description and fidelity assessment of interventions and training of healthcare professionals.