Table 1 Patient education sessions in the multidisciplinary residential nutritional rehabilitation programme [42] in the NUTRI-HAB trial
SESSION | DURATION (minutes) | CONTENT | SESSION LED BY |
|---|---|---|---|
Welcome session with presentation of the programmea,d | 30 | The aim of the welcome session is to make participants feel safe and comfortable in the environment in which they will be spending the next five days. This may contribute to increased motivation and willingness to participate actively throughout the programme [43, 44]. | Course leaderf and clinical dietitian |
Presentation rounda,d | 60 | In the presentation round, participants will share information about their background and cancer diagnosis, and they will be encouraged to use selected picture cards to narratively describe their expectations and desired outcomes of participation. The aim of the session is to enhance group formation and to establish a sense of community among participants since this may facilitate patient empowerment [45]. Central staff members (course leader, physician, clinical dietitian, and evening hostess) participate. | Course leader |
Social activitya,d | 60 | A social activity including music and movement will be scheduled on the first evening of the programme to support group formation and candidness among participants. | Music therapist |
Theoretical session on eating problemsa,d | 105 | The session will include dietary advice to manage different nutrition impact symptoms e.g. choice of foods, texture and flavour modification [24, 46]. Exchange of experiences between participants will be encouraged. | Clinical dietitian |
Individual dietary counsellingc,d,e | 30 (20 at follow-up) | In the individual dietary counselling, dietary advice will be tailored to the individual participant [24]. | Clinical dietitian |
Practical kitchen workshopb,d | 180 | In the practical kitchen workshop, participants will prepare foods of different textures and flavours, and take-home recipes will be handed out. The aim of the workshop is to inspire and put theory into practice [4], and practical kitchen sessions have supported dietary changes in studies with other types of cancer survivors [47, 48]. | Clinical dietitian |
Swallowing exercisesb,d | 90 | Participants will be instructed in different swallowing exercises and exercises for jaw and tongue mobility, since these types of exercises may reduce dysphagia and trismus [46, 49]. Participants will receive an exercise manual and a training diary, and will be encouraged to continue doing the exercises, when they come home. | Occupational therapist |
Dental problems and oral hygieneb,d | 75 | Dental problems are frequent after treatment for head and neck cancer [22]. The session will include information on how to maintain good oral hygiene and on dental reimbursement rules in relation to cancer treatment. | Dental hygienist |
Physical activitya,d,e | 75 | Physical activity may contribute to ameliorate late effects associated with decreased physical function in cancer survivors [50,51,52,53]. In the physical activity sessions, participants will be introduced to different kinds of physical activity that they can do at home e.g. balance or resistance training exercises. Exercises will be adjusted to the participants’ training level. | Physiotherapist |
Yogab,d | 60 | Yoga may contribute to improve quality of life and to reduce fatigue and symptoms of distress and anxiety in cancer survivors [54, 55]. The yoga session will be based on principles from Hatha yoga and Physioflow yoga. Special attention will be given to exercises aimed at releasing tensions in the head and neck area. | Physiotherapist certified as yoga instructor |
Psychological reactions to cancerb,d | 150 | The session will be based on a psychoeducational approach [56, 57] and will aim at supporting participants’ coping of everyday life after cancer. The session will comprise psychologist’s presentation of frequent psychological reactions to cancer and discussions in small groups. | Psychologist |
The existential dimension of rehabilitationa,d | 90 | The session is a group conversation on questions of existential and spiritual character that often follow the diagnosis of a life-threatening disease [58, 59]. | Priest |
Massage therapyc,d | 45 | Massage therapy may contribute to short term reduction of pain and anxiety even though the level of evidence is very low [60]. Each participant will receive 45 min of relaxing massage therapy and will have to choose between a full body relaxing massage or special attention given to a certain area e.g. tensions in the neck. | Massage therapist |
Vocational counsellingb,d | 75 | Optional session. Vocational counselling session will aim to support return-to-work processes and hence participants functioning in accordance with the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) [61]. The session will include information on rights and obligations according to Danish legislation. | Social worker |
Fatigue and sleep problemsb,d | 75 | Optional session on reasons for and management of cancer-related fatigue [52, 62] and sleep problems [63, 64]. | Nurse |
Motivation, goal setting and action plansa,d | 100 | Based on principles of motivational interviewing [65], the session will allow participants to reflect on, how they will implement new inspiration and knowledge gained through the programme, when returning back home. | Course leader |
Intimacy and sexualityb,e | 90 | Optional session. Based on the PLISSIT model [66], the session will address how sexuality and intimacy can be affected by cancer and cancer treatment [67, 68] and provide advice for management of potential challenges. Participants will be divided into groups by gender for the session. | Sexologist |
Meaning and values in lifeb,e | 90 | Optional session. Based on principles of acceptance and commitment therapy [69], the session will aim to support participants in re-establishing meaning in life through reflections on values and sources to meaning in lif e[70, 71]. | Psychologist |
Individual counsellingc,d,e | 30–45 | Individual counselling with relevant health professionals (e.g. speech pathologist, physician) will scheduled depending on participants’ needs. | Depending on need |