Introduction
Methods
Design
Participants and recruitment
Healthcare professionals
Patients
Data collection
Data analysis
Results
Participant characteristics
ID | Role | Years of service | Aware of PA guidelines | Routinely promote PA |
---|---|---|---|---|
HCP1 | Clinical oncologist | 3 | Yes | yes |
HCP2 | Chemotherapy nurse | 2 | no | no |
HCP3 | Consultant chemotherapy nurse | 11 | no | yes |
HCP4 | Lead oncology nurse | 4 | no | no |
HCP5 | Lead cancer clinical nurse specialist | 19 | no | no |
HCP6 | Surgeon | Missing | Missing | no |
HCP7 | Oncologist | 15 | yes | no |
HCP8 | Oncologist | 17 | yes | no |
HCP9 | Advanced nurse practitioner | 3 | no | no |
HCP10 | Consultant clinical oncologist | 19 | no | no |
HCP11 | Consultant medical oncologist | 3 | no | no |
ID | Age (years) | Employment status | Ethnicity | BC grade | Time since diagnosis (years) | Adj/Neo Adj chemotherapy | NHS/private (P) healthcare | Location of treatment | Total mins MVPA | PA discussion with clinician (Y/N) | Awareness of cancer and PA guidelines (Y/N) |
---|---|---|---|---|---|---|---|---|---|---|---|
P001 | 39 | Self-employed | White | 2 | 2 | Adjuvant | NHS | Bath | 450 | Y | N |
P002 | 51 | Employed | White | 3 | 13 | Adjuvant | NHS | Leicester | 360 | N | Y |
P003 | 51 | Self-employed | White | 2 | 10 | Neo-adjuvant | NHS | Slough | 0 | N | N |
P004 | 64 | Retired | White | 3 | 5 | Neo-adjuvant | NHS | Leicester | 60 | N | N |
P005 | 62 | Retired | White | 3 | 5 | Adjuvant | NHS + P | Leicester | 260 | N | N |
P006 | 50 | Sick leave | White | 3 | < 1 | Neo-adjuvant | NHS + P | Glasgow | 135 | Y | N |
P007 | 35 | Sick leave | Black African | 3 | < 1 | Neo-adjuvant | P | London | 360 | Y | Y |
P008 | 47 | Employed | White | Missing | 1 | NA | NHS | Plymouth | 280 | N | N |
P009 | 46 | Employed | White | 2 | < 1 | Neo-adjuvant | NHS | Newcastle | 240 | N | Y |
P010 | 36 | Employed | White | 2 | 2 | Adjuvant | NHS | Kent | 315 | N | N |
P011 | 55 | Unemployed | White | Missing | < 1 | Adjuvant | NHS | Leicester | 90 | N | N |
P012 | 60 | Employed | White | 2 | 2 | Adjuvant | NHS | Leicester | 310 | N | N |
P013 | 44 | Self- employed | White | 2 | < 1 | Adjuvant | P | Milton Keynes | 90 | Y | Y |
P014 | 42 | Employed | White | 3 | < 1 | Adjuvant | P | Milton Keynes | Missing | Y | N |
P015 | 63 | Unemployed | White | 2 | < 1 | neo-adjuvant | NHS | Bath | 120 | Y | N |
Themes
Theme 1: Current practice
Limited physical activity advice
Theme | Sub-theme | Quotations |
---|---|---|
Current practice | Limited PA advice | HCP5: I think it’s probably down to individual teams if they’ve got people in there who actually. You know, believe in the benefit of physical activity HCP2: Where I work, obviously we promote it by like asking how people are getting on, like if they’re feeling fatigued. If they’re able to, like do normal things that they might do if they were like avid gym goers or runners or something. But then it’s just kind of dismissed |
Reactive conversations | HCP5: I do talk to them about it, but it’s probably not something that automatically comes into conversations unless that I can either see a need or people are expressing. “Ohh really wish I can get back to the gym”, that type of thing HCP9: Yeah, I guess if it comes up in conversation or patients say this troubling about the weight or things like that then then I would talk about it HCP 6: I think I would be honest and just say its more than likely if a patient mentions it, then I will do it, but I just, if you’re already giving them a lot of information and as well where I just think it’s almost the sort of thing that you could drip feed in later | |
Perceived benefits in: NHS Private care: | P01: I know for my mental and physical health how important keeping active was and like I say, the fatigue you kind of think I just need to rest, but actually it helped me manage my fatigue a lot more HCP10: So I understand it has an important role to play because and not just in terms of people’s sort of emotional, mental, psychological well-being, but their physical well-being as well, because then I know that a little bit of exercise can help boost and their energy even in people who are quite fatigued and from their disease or their treatments… HCP1: during treatment and after treatment is very beneficial, so during treatment it helps in a uh, to battle fatigue after treatment. It helps to prevent recurrence in or things like that P013: And he absolutely drummed into me heart, heart, heart. Go look after it. Through chemo, you gotta keep moving. You gotta keep heart rate up and you know, you’ve got to keep exercising and how important it is to protect your heart through chemo through exercise | |
Implementation in care | Remote resources | P10: it’s a lot to take in, but I think if you’re given all the leaflets and stuff, and then you can obviously take them home and discuss them with friends and relatives, that’s probably a really good time as well. I think definitely leaflets, something written down because you’re taking so much in all the time. And certainly when you’re really stressed, it’s very difficult to remember everything from an appointment P015: But I mean with the proliferation of apps, maybe an app with targets to reach each day would be helpful HCP1: but would be nice to have something to give them. You know something that can be in clinic and just used to encourage them |
Home-based | P10: people that are going through treatment are more likely to spend more time at home, rather than out in a class or something, just because of energy levels | |
Credible source | P11: But knowing that it’s research based is important for me because you have got common sense because goes out the window because I’ve never been ill P05: if they’re saying you should be doing this, you know, they know what they’re talking about sort of thing! So yeah, I would … that would motivate me as well, yeah P15: In an ideal world, I think it should come from a medical practitioner! Because it would give it more credibility | |
Inclusivity | P09: I definitely think the advice should be for everyone to maintain any and you know, and if possible improve obviously very active people might not be able to improve, but with the idea to help people maintain though, HCP6: I would say that I would think that there’s probably a way in which they could all be physically active HCP11: even people who are wheelchair bound you know? Or nursing homes? I know they often have, you know physical exercise programs where they can do stretches and arm things and give various different things with their legs and rotate their ankles and bring their knees up to their chests and that type of thing so | |
Changing perceptions | P15: I was constantly told by family, don’t overdo it, don’t go too far, you know … and sort of fighting that … in a way, I mean there was some encouragement to go for a walk but not to go more than round the block at times you know and … so any kind of information in printed form that I could show them would have been helpful P03: The business about people saying, oh, we should conserve your energy and you shouldn’t exercise while you’re on treatment. I think would be useful to have some maybe. Maybe if they’ve got some common myths busting them as well, that would be. I think that would be useful HCP5:. I’ve been sitting with patient who have been given a diagnosis, and I’ve had sort of the family member saying. Right, OK, you go home, we’ll go home and you just sit down and you won’t have to do anything. And we’ll get people coming in to do this and that. Hold on a moment. Yeah, that sounds very lovely and very supportive. However, we want you to keep up and about, you know | |
Frequency and timing of conversations | P05: but it might be something that might need to be given more than once, if you know what I mean because you might be given that information on your pre-op visit but you might not be in a position that you feel well enough to do anything for a while and then you might forget about it or you know …So I suppose you’d need some follow-up between each to see … you know it could be part of the check-in couldn’t it P06: I think throughout because I experienced different things at different points of my treatment P11: definitely when you’re embarking on your active treatment at that earlier point to make a connection and maybe halfway through because then you’re sort of a bit more chemo savvy P14: it needs to be driven home again, you know, or it can be driven home again at that point if it’s in your head like two or three weeks before you start chemo, then you’re already thinking about it when you are OK well, you know I can I can plan for this HCP8: And I think it’s probably a repeated thing for a number of reasons. So inevitably there needs to be a you know, followed up and tracked going along. So I think that there are perhaps key nodal points, when it it’s really helpful to introduce it | |
Social support | P13: I think if you could get like buddies like a buddy system. So say someone like me who’s been through it, who has done the exercise P02: It needs a bit more time and sympathy, not someone that’s going, oh come on just get on with it, they need someone that’s been through it, understands how hard it is and has patience and understanding, I think that’s real key | |
Training | Requests for training | HCP1: So I think that’s where the training or teaching would be helpful to know when to integrate it to patients and how to integrate it HCP 11: And training session would be good HCP4: I think it has, it’s more of a topic now that people are aware of but a training package and some advice and what sort of and how you would assess and what physical activity is appropriate HCP6: And up-to-date information. Basically, for the clinicians that would be involved in it, and wouldn’t there’s an educational aspect of things that would be needed amongst the staff that were going to be delivering HCP9: kind of like education in a team and to know what words you’re going to use to make sure people understand it and what you’re actually asking of them and what you’re suggesting of them |
Evidence-based info | HCP11: If there is data there that I can come can see, then I think that would help HCP8: I think some of the key evidence base that supports it,’cause you know, we’re very evidence driven in oncology HCP5: I think the information with the evidence behind it | |
Guidance | HCP11: And in terms of physical activity, what types of physical activity are safe? HCP10: given them some pointers, the types of exercises, the duration of exercise. So getting that balance between doing the physical activity where it’s going to boost their energy and help them with their treatment but not so much that they’re going to be exhausted and then not be able to carry on with their treatment HCP5: I think it’s a lot of times we’re gonna have to be doing really small steps with patients. So you know how, what are the ways to if you’ve got someone who’s completely inactive, who really and we do have completely inactive people, how do you start off, how do you, how do you get that motivation? How do you get that? What are the, what are the key sort of like terms or words to use that you know, what’s the health benefit? |