Evaluation of a One-Week Occupation-Based Program on the Health and Participation of Women With Cancer Living in the Community

PURPOSE: Improvements in medical treatments have led to women with cancer living longer in the community. However, there are a limited number of services that help these women reengage in occupations on completion of treatment. The demand to provide services for this growing population of cancer survivors is becoming a national concern and requires occupational therapists to address their needs. The purpose of this study was to engage women diagnosed with cancer in activities that have a physical, social, and emotional impact and to evaluate if they showed improvements in functional health, quality of life, and occupational performance.

DESIGN: This study used a prospective, one-group pretest–posttest design. Women diagnosed with cancer living in the community were purposively recruited. We targeted underserved communities in urban, suburban, and rural areas. Recruitment flyers were posted in clinics, hospitals, churches, and support communities. Eligibility criteria for this study were women diagnosed with cancer, age 21+ yr, and clearance from a physician to participate in the program. We recruited 77 women for this study.

METHOD: The intervention was a 1-wk activity-based program based on the Occupational Therapy Practice Framework (American Occupational Therapy Association, 2014). Activities included physical, emotional, spiritual, sensory, and educational components. Three outcome measures were used: (1) Short-Form Health Survey (SF–36), a generic measure of functional health and well-being; (2) World Health Organization’s Quality of Life–Brief version (WHOQOL–BREF), which assesses perceptions of quality of life; and (3) Canadian Occupational Performance Measure (COPM), which measures changes in a client’s perception of occupational performance and satisfaction over time. All three assessments were administered at pretest (Day 1) and 6-wk follow-up. The COPM was also administered at posttest (Day 5). Six paired t tests were conducted to evaluate differences between pretest and follow-up for the SF–36 and the WHOQOL–BREF. Two repeated-measures analyses of variance were conducted to evaluate differences between the three time points for the COPM. Cohen’s d _z and partial eta squared (η_p ²) were used to calculate effect sizes.

RESULTS: A significant difference was obtained in the WHOQOL–BREF subscale of Social Relationships with a moderate effect (p = .002, d _z = .37). No significant differences were found for any of the other subscales of the SF–36 and WHOQOL–BREF, although the SF–36 Mental Health subscale approached a moderate effect size (d _z = .28). COPM Performance scores differed significantly with a large effect size (p = .000, η_p ² = .374). COPM Satisfaction was also significant with a large effect size (p = .000, η_p ² = .309). Post hoc analyses for Performance and Satisfaction across the different time points showed that all comparisons were significant (p < .003) with large effect sizes (ranging from .523 to .673).

CONCLUSION: This study established the effectiveness of an activity program in improving the perception of occupational performance and satisfaction of women diagnosed with cancer living in the community. This implies that participation in the program translated to improvements in occupational functioning. Additionally, improvements were seen in social relationships. This finding has tremendous implications that highlight the role of being engaged in activities and its impact on functioning.

IMPACT STATEMENT: This study tested a community-based intervention for women with cancer. Community practice is an emerging area of occupational therapy practice, and this study provides an evidence-based intervention. This type of programming, though of a short duration, has a long-term impact on women with cancer living in the community, who typically do not receive occupational therapy services.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006

Bonomi, A., Patrick, D., Bushnell, D. M., & Martin, M. (2000). Validation of the United States’ version of the World Health Organization Quality of Life (WHOQOL) instrument. Journal of Clinical Epidemiology, 53, 1–12. https://doi.org/10.1016/S0895-4356(99)00123-7

Dedding, C., Cardol, M., Eyssen, I. C., & Beelen, A. (2004). Validity of the Canadian Occupational Performance Measure: A client centered outcome measurement. Clinical Rehabilitation, 18, 660–667. https://doi.org/10.1191/0269215504cr746oa

McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-Item Short-Form Health Survey (SF–36^®): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247–263.