EHR523: Complex Clinical Reasoning and Decision-Making in Exercise Oncology

Vocabulary flashcards covering the core clinical reasoning principles, priority hierarchies, care pathways, and decision-making strategies in exercise oncology presented by Jack Cannon.

Principle 1: Treat the Person, Not the Diagnosis

The clinical principle stating that a cancer diagnosis provides context rather than the answer, requiring clinicians to understand individual goals, functional abilities, symptoms, and psychosocial circumstances.

Dietitian Referral

An allied health referral indicated when an oncology patient presents with cachexia or significant weight loss.

Physiotherapist Referral

An allied health referral indicated when an oncology patient presents with mobility limitations or neurological impairments.

Psychologist Referral

An allied health referral indicated when an oncology patient experiences fear of movement, anxiety, or emotional distress.

Social Worker Referral

An allied health referral indicated when an oncology patient encounters social, practical, or financial challenges.

Principle 2: Prioritise Before Prescribing

The decision-making principle emphasizing that not all clinical issues can be addressed simultaneously; care must focus first on factors with the greatest impact on safety, function, and participation.

Priority 1: Address Immediate Safety Concerns

The initial clinical priority focused on identifying and stabilising urgent risks—such as significant neurological changes, severe mobility limitations, or acute symptom escalation—before progressing exercise.

Priority 2: Preserve Function and Independence

The clinical priority focused on maintaining or restoring a patient's capacity to safely perform everyday activities, such as activities of daily living (ADLs), transferring, walking, and stair negotiation.

Priority 3: Manage Symptoms and Treatment Effects

The clinical priority focused on mitigating adverse cancer and treatment side effects, such as fatigue, neuropathy, and pain, to improve daily life and exercise participation.

Priority 4: Build Physical Capacity

The clinical priority focused on developing aerobic fitness, muscular strength, balance, and general physical activity participation to attenuate declines and enhance recovery.

Priority 5: Pursue Long-Term Health and Lifestyle Goals

The clinical priority addressing broader, enduring outcomes beyond immediate cancer treatment, including weight management, cardiometabolic health, and return to work.

Principle 3: Focus on Meaningful Outcomes

The principle stating that intervention targets should reflect what matters most to the individual patient rather than solely standardized metrics of fitness or exercise volume.

Meaningful Outcomes: During Treatment

Clinical success defined primarily by maintaining physical function and supporting the patient in completing planned medical treatments.

Meaningful Outcomes: Following Treatment

Clinical success defined by recovering physical capacity and facilitating a return to normal life and meaningful activities.

Meaningful Outcomes: Advanced Disease

Clinical success defined by preserving functional independence and slowing the rate of physical decline.

Meaningful Outcomes: Palliative Care

Clinical success defined by maintaining personal autonomy, dignity, quality of life (QOL), and ongoing participation.

Principle 4: Managing Clinical Risk

The process of weighing potential hazards against therapeutic benefits within a patient's clinical context, aiming to maximize meaningful benefit while maintaining acceptable risk.

Competing Clinical Priorities (Trade-Offs)

Complex decision-making tensions in exercise oncology, such as exercise progression versus symptom burden, independence versus safety, loading versus skeletal risk, and capacity building versus energy preservation.

Principle 5: Accept and Manage Uncertainty

The principle recognizing that oncology decisions often involve incomplete information, limited referral details, or evidence gaps, requiring evidence-informed clinical judgment.

Principle 6: Reassess and Adapt

The practice of keeping exercise prescriptions flexible and responsive by regularly monitoring changes in patient symptoms, disease status, treatments, and goals.

Decision-Making Pitfalls in Exercise Oncology

Common clinical missteps including over-emphasising risk leading to under-prescription, attempting to address too many issues at once, applying guidelines rigidly without individualisation, and failing to adapt to evolving circumstances.