Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Cancer health care professionals’ confidence in referring cancer survivors to exercise support: a qualitative study (#446)

Christopher J McHardy 1 , Jia (Jenny) Liu 2 3 4 , Roy T.H. Cheung 1 , Haryana Dhillon 5
  1. School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
  2. The University of Sydney, Camperdown, NSW, Australia
  3. St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia
  4. The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia
  5. Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia

Background: Exercise during active cancer treatment improves cancer survivor (CS) outcomes. However, only 30% of CS achieve exercise guideline recommendations and less than 20% are referred for exercise intervention.

Aims: We explored cancer healthcare professionals (CHCPs) perceptions of their knowledge, skill, and confidence making exercise referrals.

Methods: We conducted a prospective qualitative study. Semi-structured interviews were conducted with CHCPs who were invited via professional groups and snowballing. Interviews were conducted on Zoom, recorded, transcribed and analysed using Interpretative Description methods to facilitate translation into practice. Interviews continued until information power was achieved.

Results: Interviews were conducted with 28 participants (17 oncologists, 7 nurses, 4 surgeons) between April-June 2024. We identified three key themes:

Exercise discussion timing: CHCPs consistently confirmed the value of exercise for CS but were unsure of the optimal timepoint to discuss exercise and which CHCP was primarily responsible. In the absence of a clinical pathway and service, implementation of routine exercise referrals were challenging.

Clinical environment:  Appointments early in treatment are too overwhelming for patients to absorb detailed exercise advice. Exercise discussion in follow-up appointments perceived suitable when clinically safe for CS. Survivorship clinics have more time for comprehensive exercise discussions though are not equitably available.

Clinician knowledge: Clinicians perceived having an adequate understanding of aerobic exercise prescription. However, they were less confident in making resistance exercise recommendations and approving a CS as safe to exercise. CHCPs required guidance from ES regarding which information in a referral is useful to them to optimise use of consultation time for both CHCP and ES. Bi-directional communication between exercise providers and referrers would benefit CS care.

Conclusion: CHCP require training in optimal exercise advice to increase confidence in making exercise referrals. A referral pathway to an exercise resource or service may facilitate greater adherence to exercise recommendations and accessibility.