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A perfect storm and patient-provider breakdown in communication: two mechanisms underlying practice gaps in cancer-related fatigue guidelines implementation



Cancer-related fatigue (CRF) is a debilitating symptom experienced by many cancer patients. Although guidelines provide evidence-based recommendations for screening, assessing, and managing CRF, there is limited evidence of their implementation in practice. This study aimed to explore patients’, healthcare providers’ (HCPs), community support providers’ (CSPs) experiences and opinions on CRF guidelines and the underlying causes of CRF treatment gaps following the Knowledge-to-Action model.


A total of 62 participants were recruited—16 patients, 32 HCPs, and 14 CSPs—for a total of 9 focus groups and 4 individual interviews. Sessions were recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis.


There were gaps in the application of CRF guidelines and patient dissatisfaction with care. Two underlying mechanisms may contribute to these gaps. First, professionals’ lack of knowledge and resources paired with systemic obstacles created difficult conditions to adequately address CRF—A Perfect Storm. Further, patient-provider communication gaps lead to patients feeling discouraged to report issues to their healthcare teams and turning to community services for help—A Breakdown in Communication.


There is little indication that CRF guidelines are routinely implemented in clinical practice. This study provides insights from various perspectives to aid understanding of the critical issues that require consideration to increase implementation of CRF guidelines by HCPs. As patients are currently dissatisfied with CRF-related care, implementation of CRF guidelines is needed.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.


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This study was supported by clinical pilot study grant and dissemination grant from the Institut du Savoir Montfort as well as scholarships from the Fonds de recherche du Québec–Société Culture and the Institut du Savoir Montfort held by the first author. Ms. Gollish and Ms. Trudel also received summer student awards from the Institut du Savoir Montfort to support their work on this project.

Author information




All authors contributed to the study conception and design. Material preparation and data collection were performed by Georden Jones, Marguerite Gollish, Geneviève Trudel, Nicole Rutkowski, Jennifer Brunet, and Sophie Lebel. Data analysis was performed by Georden Jones with double coding performed by Geneviève Trudel and Nicole Rutkowski. The first draft of the manuscript was written by Georden Jones and all authors provided critical feedback on the manuscript. All authors read and approved the final manuscript.

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Correspondence to Georden Jones.

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Jones, G., Gollish, M., Trudel, G. et al. A perfect storm and patient-provider breakdown in communication: two mechanisms underlying practice gaps in cancer-related fatigue guidelines implementation. Support Care Cancer 29, 1873–1881 (2021).

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  • Cancer-related fatigue
  • Clinical guidelines
  • Healthcare research
  • Knowledge translation
  • Qualitative methods