From theory to practice: designing interventions to reduce fatigue in patients with cancer.

PURPOSE/OBJECTIVES: To review the evidence available to guide the development of interventions to alleviate cancer-related fatigue. DATA SOURCES: Published fatigue theories and research describing patients' self-care strategies and the efficacy of interventions for the management of fatigue. DATA SYNTHESIS: Fatigue is a pervasive problem for patients with cancer. Without guidance, patients adopt common-sense strategies that generally prove unsuccessful in alleviating fatigue. Theories that identify self-care actions that can reduce fatigue are becoming increasingly sophisticated. A small number of strategies, most notably exercise, has been evaluated. Other interventions--educational, attention-restoring, and psychosocial--have been tested to a lesser extent. The theoretical foundations of these experimental studies frequently are unclear. However, primary evidence is favorable and supports further evaluation. CONCLUSIONS: Passive approaches frequently fail to reduce fatigue in patients with cancer. Alternative approaches based on the growing body of theoretical and research evidence should be adopted. IMPLICATIONS FOR NURSING PRACTICE: Patients require guidance in managing cancer-related fatigue. Nurses need to develop and evaluate relief interventions. Systematic research programs based on sound theoretical premises and previous research will contribute to the growing body of evidence to aid future management of this troublesome symptom