Introduction
Methods
Level | Barriers/incentives |
---|---|
Innovation | Advantages in practice, feasibility, credibility, accessibility, attractiveness |
Individual professional | Awareness, knowledge, attitude, motivation to change, behavioural routines |
Patient | Knowledge, skills, attitude, compliance |
Social context | Opinion of colleagues, culture of the network, collaboration, leadership |
Organizational context | Organization of care processes, staff, capacities, resources, structures |
Economic and political context | Financial arrangements, regulations, policies |
Category | Inclusion criteria | Exclusion criteria |
---|---|---|
Population | People with an experience related to implementation of exercise into cancer care, including but not restricted to: People receiving the program People living with and beyond cancer People referring into an exercise program: Oncologists Nurses General practitioners People delivering an exercise program: Exercise physiologists Physiotherapists People implementing an exercise program: Hospital administrators Program administrators People designing exercise programs: Researchers | Age ≤ 18 years |
Concept | Literature describing barriers to accessing or implementing exercise programs | Barriers unrelated to issues of implementation (e.g. personal motivation) Barriers that were anticipated, not experienced Reported exercise preferences, not experienced barriers |
Context | Outpatient clinical care | Exercise programs that are not linked into healthcare, either via clinician referral or location (e.g. co-located) In-patient exercise programs Non-real-world programs (e.g. clinical trials) |
Study design (and study feature) | Any design inclusive of original research English language only Published 2010–2020 | Reviews or meta-analyses Guidelines or position stands Program descriptions Insufficient detail to determine any relevant study content |
Search strategy
Data extraction and synthesis
Results
Study and participant characteristics
Author and study year | Country | Study design | Stakeholder group (n) | Cancer type | Context | Concept |
---|---|---|---|---|---|---|
Agasi-Idenburg et al. 2020 [70] | Netherlands | Qualitative | Patients (n = 15) Healthcare providers (n = 9) | Colorectal | Netherlands Cancer Institute | Barriers for preoperative exercise programs for older patients scheduled for colorectal cancer surgery |
Beidas et al. 2014 [35] | USA | Qualitative | Healthcare providers (n = 19) | Breast | NCI designated comprehensive cancer centre and associated physical therapy clinic | Barriers to implementation of efficacious exercise intervention for breast cancer survivors experienced by referring oncology clinicians and physiotherapists who delivered the program |
Blaney et al. 2010 [71] | Northern Ireland | Qualitative | Patients (n = 26) | Multiple | Regional Cancer Centre in Belfast | Barriers to exercise among patients with cancer related fatigue |
Bourke et al. 2018 [55]
| UK | Qualitative | Patients (n = 26) Healthcare providers (n = 38) | Prostate | National Health Service | Exercise referral and tailored exercise training embedded within prostate cancer care |
Brunet et al. 2013 [74] | Canada | Qualitative | Patients (n = 9) | Breast | Healthcare system in Canada | Active breast cancer survivors’ perceptions of factors that influence their PA participation |
Bultijnck et al. 2018 [60] | Belgium | Quantitative | Healthcare providers (n = 98) | Prostate | Hospitals across Belgium | Availability of hospital-based rehabilitation resources for prostate cancer patients |
Cantwell et al. 2018 [36] | Ireland | Multi-method (Delphi method) | Healthcare providers (n = 91) | Multiple | Healthcare system across Ireland | Barriers to PA promotion for cancer survivors |
Cantwell et al. 2020 [67] | Ireland | Qualitative | Patients (n = 41) | Multiple | Cancer support centre and community-based exercise rehabilitation program | Experiences of PA behaviour across the cancer journey |
Cheville et al. 2012 [75] | USA | Qualitative | Patients (n = 20) | Lung | A single cancer treatment service | Perceived barriers for exercise and exercise-related instructions received from their professional caregivers |
Culos-Reed et al. 2019 [65] | Canada | Qualitative | Patients (n = 11) | Prostate | Community-based lifestyle management program | Patient perspectives of the community-based TrueNTH Lifestyle Management program |
Dalzell et al. 2017 [33] | Canada | Quantitative | Patients (n = 1,635) | Multiple | Segal Cancer Centre within the Jewish General Hospital, Montreal Quebec | Evaluation of implementation of rehabilitation and exercise oncology program (ActivOnco) within hospital setting |
Dennett et al. 2017 [63] | Australia | Qualitative | Healthcare providers (n = 15) | Multiple | Australian oncology rehabilitation programs | Barriers to exercise program implementation |
Dennett et al. 2020 [37] | Australia | Qualitative | Patients (n = 9) Healthcare providers (n = 25) | Multiple | Large, public, metropolitan health service | Barriers to implementing an exercise-based rehabilitation program in an acute setting for cancer survivors receiving treatment |
Fernandez et al. 2015 [76] | Canada | Mixed | Patients (n = 30) | Multiple | Outpatient physiotherapy programs or established cancer support organizations in communities within Ontario | Barriers to exercise in individuals with cancer |
Fitzpatrick et al. 2014 [62] | USA | Mixed | Healthcare providers (n = 50) Researchers (n = 84) | Multiple | Research and clinical settings across USA | What needs to happen for exercise to become part of standard care for cancer survivors once treatment ends |
Fong et al. 2018 [24] | Canada | Qualitative | Healthcare providers (n = 27) | Breast | Regional cancer centres across Ontario | Factors affecting PA counselling in clinicians |
Fong et al. 2018 [32] | Canada | N/A | N/A | Breast | Regional cancer centres across Ontario | Built environment scan of PA infrastructure |
Granger et al. 2016 [38] | Australia | Qualitative | Healthcare providers (n = 17) | Lung | University of Melbourne-affiliated hospital networks | Barriers that influence clinicians’ translation of the PA guidelines into practice |
Granger et al. 2019 [64] | Australia | Qualitative | Patients (n = 7) | Lung | Community around The University of Melbourne, Australia | Explore patient experiences of PA after a lung cancer diagnosis |
Hardcastle et al. 2018 [39] | Australia | Qualitative | Patients (n = 20) | Multiple | State sponsored outpatient group exercise program in Western Australia | Factors influencing non-participation in structured exercise program for cancer survivors |
Haussmann et al. 2018 [40] | Germany | Quantitative | Healthcare providers (n = 675) | Multiple | Outpatient oncology care settings across Germany | Structural barriers perceived as impeding by healthcare providers for promoting PA to patients |
Haussmann et al. 2018 [56] | Germany | Qualitative | Healthcare providers (n = 30) | Breast, prostate, and/or colon | Outpatient and inpatient settings in Baden-Wuerttemberg, Germany | Influencing factors for healthcare providers’ PA promotion behaviour and reasons and mechanisms behind them |
Höh et al. 2017 [41] | Germany | Quantitative | Patients (n = 905) | Multiple | Federal association of cancer self-help | Experience with PA in cancer |
Hubbard et al. 2018 [73] | UK | Mixed | Patients (n = 32) | Breast | UK hospital serving rural and urban population | Acceptability and feasibility of post-surgery referral to existing community-based PA programs |
IJsbrandy et al. 2019 [42] | Netherlands | Qualitative | Patients (n = 34) | Multiple | Hospitals in the Netherlands | Factors that influence the implementation of PA programs |
IJsbrandy et al. 2020 [43] | Netherlands | Qualitative | Healthcare providers (n = 70) | Multiple | Dutch healthcare system | Factors affecting delivery of PA programming in a shared-care model |
Kang et al. 2014 [72] | Republic of Korea | Quantitative | Patients (n = 427) | Colorectal | Shinchon Severance Hospital | Barriers to exercise in colorectal cancer patients and survivors |
Karvinen et al. 2012 [44] | USA | Quantitative | Healthcare providers (n = 274) | Multiple | Oncology care settings across the USA | Barriers to PA promotion among oncology nurses |
Kennedy et al. 2020 [45] | Australia | Qualitative | Patients (n = 119) Healthcare providers (n = 15) | Multiple | Private oncology outpatient clinic | Barriers to implementation of co-located exercise clinic |
Keogh et al. 2014 [77] | Australia | Qualitative | Patients (n = 14) | Prostate | Private and public healthcare system | Barriers to PA in men with prostate cancer |
Keogh et al. 2017 [46]
| Australia and New Zealand | Quantitative | Healthcare providers (n = 119) | Multiple | Private and public oncology care across Australia and New Zealand | PA promotion barriers of oncology nurses |
Ligibel et al. 2019 [47] | USA* | Quantitative | Healthcare providers (n = 812) | Multiple | International oncology practice | Practice patterns around assessment of body weight, PA, and nutrition and referrals to relevant programs to support behaviour change after a cancer diagnosis |
Maxwell-Smith et al. 2017 [78] | Australia | Qualitative | Patients (n = 24) | Colorectal | St. John of God Hospital, Perth Australia | Explore colorectal survivors’ experiences and barriers towards PA among those with comorbidities |
Mulcahy et al. 2018 [58]
| Ireland | Qualitative | Organizational stakeholders (n = 24) | Multiple | Specialised cancer centres, public and private hospitals and palliative care settings across Ireland | Barriers to the provision of physiotherapy exercise rehabilitation services available to patients with cancer |
Nadler et al. 2017 [18] | Canada | Quantitative | Healthcare providers (n = 120) | Multiple | Juravinski Cancer Centre in Hamilton, Ontario | Determine oncology care providers barriers to exercise discussion |
O’Hanlon et al. 2014 [48] | Ireland | Quantitative | Healthcare providers (n = 84) | Multiple | Oncology care across Ireland | Identify barriers to prescribing exercise for cancer care |
Park et al. 2015 [49] | Republic of Korea | Quantitative | Healthcare providers (n = 165) | Multiple | Oncology care across the Republic of Korea | Barriers to recommending exercise to cancer survivors |
Patel et al. 2018 [69] | New Zealand | Qualitative | Healthcare providers (n = 16) | Prostate | Private and public practices in New Zealand | Influences on practitioners to not promote PA to their patients with prostate cancer |
Perry et al. 2020 [61] | USA | Mixed | Patients (n = 61) Healthcare providers (n = 11) | Breast | University cancer centre in Pacific Northwest | Attitudes and beliefs regarding exercise counselling and structured exercise programs within cancer care |
Roberts et al. 2019 [57] | UK | Qualitative | Healthcare providers (n = 19) | Breast, prostate, colorectal | Breast, prostate and colorectal care across the UK | Perspectives on PA promotion |
Rogers et al. 2019 [66] | USA | Qualitative | Healthcare providers (n = 14) Organizational stakeholders (n = 12) Community stakeholders (n = 4) | Mixed | Rural community setting | Identify constructs relevant to implementation of evidence-based PA behaviour change interventions for rural women cancer survivors from an organizational perspective |
Romero-Elias et al. 2020 [50] | Spain | Qualitative | Patients (n = 10) Healthcare providers (n = 10) | Colorectal | Oncology unit of a Spanish hospital | Barriers patients perceive to participate in PA during chemo + views of physicians |
Santa Mina et al. 2015 [51] | Canada | Qualitative | Organizational level (n = 13) | Multiple | Cancer exercise programs offered across Canada | Understand process of program implementation and barriers to program success |
Shea et al. 2020 [52] | Canada | Qualitative | Healthcare providers (n = 20) Organizational stakeholders (n = 10) | Multiple | Atlantic Canadian cancer centres and organizations with PA programs tailored for cancer survivors | Explore barriers to program implementation |
Smaradottir et al. 2017 [53] | USA | Qualitative | Patients (n = 20) Healthcare providers (n = 9) | Multiple (excluding breast) | Gundersen cancer centre | Barriers to implementing an exercise program during cancer treatment |
Smith et al. 2017 [79] | UK | Qualitative | Patients (n = 19) | Multiple | UK cancer centres | Explore cancer survivors’ potential barriers to exercise |
Smith-Turchyn et al. 2016 [54] | Canada | Qualitative | Healthcare providers (n = 24) | Breast | Outpatient cancer centres across southwestern Ontario | Barriers of exercise promotion for women with breast cancer |
Spost
2015 [59] | USA | Qualitative | Healthcare providers (n = 36) | Breast | Factors that prevent from recommending exercise | |
Sutton et al. 2017 [68] | UK | Qualitative | Patients (n = 16) Healthcare providers (n = 10) | Prostate | Tertiary referral hospital urology department southwest of the UK | Experiences of provision of PA advice following diagnosis of and treatment for prostate cancer |
Tomasone et al. 2017 [34] | Canada | Qualitative | Healthcare providers Organizational stakeholders Community stakeholders (n = 124)** | Multiple | Cancer programs in Ontario | Determine strategies for implementation of ‘exercise for people with cancer’ guideline |
Barriers to program implementation
Organizational context
Capacity
Staff and resources
Structures and organization of care processes
Individual professional
Knowledge
Attitude
Innovation
Advantages in practice
Accessibility
Patient
Knowledge
Economic and political context
Policies and financial arrangements
Social context
Collaboration and leadership
I do think it probably is part of our role to be doing that but I don’t think it’s solely our role…we don’t always get to clinics to see patients for a follow-up, so consultants have to…take some of that responsibility as well… (colorectal cancer nurse specialist) [57] (p. 819).
You have to have support from the upper end, the decision makers in order for any of this to even happen, you know minus all the barriers with health professionals and the actual participants themselves and what not. If you do not have funding and the support, then it’s not going to happen [52].