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Supportive Care in Cancer

, Volume 26, Issue 9, pp 3117–3126 | Cite as

A qualitative analysis of oncology clinicians’ perceptions and barriers for physical activity counseling in breast cancer survivors

  • Angela J. Fong
  • Guy Faulkner
  • Jennifer M. Jones
  • Catherine M. Sabiston
Original Article

Abstract

Background

Few breast cancer survivors (BCS) engage in sufficient physical activity (PA) to gain physical and mental health benefits. This may be due to a lack of appropriate PA information and support. While key messengers of PA information could be oncology clinicians, many do not consistently counsel their patients on PA.

Purpose

To examine factors affecting PA counseling in clinicians and inform future strategies.

Methods

Focus groups were conducted with clinicians (N = 27) at four cancer hospitals to better understand factors that affect PA counseling. Focus group discussions were transcribed verbatim and analyzed using inductive thematic analysis.

Results

Clinicians perceived a lack of training and knowledge related to PA and BCS. Clinicians also discussed being unsure of when to integrate PA counseling into different phases of survivorship. Similarly, clinicians experienced barriers from hospital administration to maintain patient flow in-clinic, which decreased opportunities for PA counseling. Additionally, lack of awareness of community-based programs within large areas served by hospitals also decreased clinicians’ self-efficacy for counseling. In order to facilitate PA counseling, clinicians wanted resources that promote patient-managed PA, available on multiple platforms (e.g., printed and online). Continued education, highlighting recent research and effective implementation of PA, was noted as an important facilitator.

Conclusions

Researchers are encouraged to develop research agendas and test educational strategies that are integrated into current practice, empirically test barriers that developed from this study with a larger, representative sample to determine salient barriers and develop PA counseling strategies that are clinician-initiated but not dependent on clinicians.

Keywords

Breast cancer Physical activity Exercise Health care providers Knowledge translation 

Notes

Acknowledgements

Guy Faulkner is supported by a Canadian Institutes of Health Research-Public Health Agency of Canada Chair in Applied Public Health. Catherine Sabiston holds a Canada Research Chair (Tier II) in Physical Activity and Mental Health.

Authors’ contributions

Conceptualization AF, CS; methodology AF, GF, JJ, CS; analysis AF, CS; initial draft of manuscript AF; and revisions AF, GF, JJ, CS.

Funding

This research is supported by the Canadian Breast Cancer Foundation (#499062).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animal participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen V, Schwartz AL, American College of Sports Medicine (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42:1409–1426.  https://doi.org/10.1249/MSS.0b013e3181e0c112 CrossRefPubMedGoogle Scholar
  2. 2.
    Tomasone JR, Zwaal C, Kim GM, Yuen D, Sussman J, Segal R (2017) Moving guidelines into action: a report from cancer care Ontario’s event let’s get moving: exercise and rehabilitation for cancer patients. Curr Oncol 24:e65–e74.  https://doi.org/10.3747/co.24.3422 CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T, Exercise for People with Cancer Guideline Development Group (2017) Exercise for people with Cancer : a systematic review. Curr Oncol 24:e290–e315CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N (2010) Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003-2006). Cancer Causes Control 21:283–288.  https://doi.org/10.1007/s10552-009-9460-6 CrossRefPubMedGoogle Scholar
  5. 5.
    Sabiston CM, Brunet J, Vallance JK, Meterissian S (2014) Prospective examination of objectively assessed physical activity and sedentary time after breast cancer treatment: sitting on the crest of the teachable moment. Cancer Epidemiol Biomark Prev 23:1324–1330.  https://doi.org/10.1158/1055-9965.EPI-13-1179 CrossRefGoogle Scholar
  6. 6.
    Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MG, Hackney AC (2014) Twenty-five years of research on the effects of exercise training in breast cancer survivors: a systematic review of the literature. World J Clin Oncol 5:177–190.  https://doi.org/10.5306/wjco.v5.i2.177 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sabiston CM, Brunet J (2012) Reviewing the benefits of physical activity during cancer survivorship. Am J Lifestyle Med 6:167–177.  https://doi.org/10.1177/1559827611407023 CrossRefGoogle Scholar
  8. 8.
    Jones LW, Courneya KS, Peddle C, Mackey JR (2005) Oncologists’ opinions towards recommending exercise to patients with cancer: a Canadian national survey. Support Care Cancer 13:929–937.  https://doi.org/10.1007/s00520-005-0805-8 CrossRefPubMedGoogle Scholar
  9. 9.
    Jones LW, Courneya KS, Fairey AS, Mackey JR (2004) Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Ann Behav Med 28:105–113.  https://doi.org/10.1037/0278-6133.24.2.189 CrossRefPubMedGoogle Scholar
  10. 10.
    Nadler M, Bainbridge D, Tomasone J, Cheifetz O, Juergens RA, Sussman J (2017) Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators. Support Care Cancer 25:2297–2304.  https://doi.org/10.1007/s00520-017-3640-9 CrossRefPubMedGoogle Scholar
  11. 11.
    Mock V, Frangakis C, Davidson NE, Ropka ME, Pickett M, Poniatowski B, Stewart KJ, Cameron L, Zawacki K, Podewils LJ, Cohen G, McCorkle R (2005) Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology 14:464–477.  https://doi.org/10.1002/pon.863 CrossRefPubMedGoogle Scholar
  12. 12.
    Karvinen KH, McGourty S, Parent T, Walker PR (2012) Physical activity promotion among oncology nurses. Cancer Nurs 35:E41–E48.  https://doi.org/10.1097/NCC.0b013e31822d9081 CrossRefPubMedGoogle Scholar
  13. 13.
    Karvinen KH, DuBose KD, Carney B, Allison RR (2010) Promotion of physical activity among oncologists in the United States. J Support Oncol 8:35–41PubMedGoogle Scholar
  14. 14.
    Guba E, Lincoln Y (1994) Competing paradigms in qualitative research. Hanb. Qual Res 105:163–194Google Scholar
  15. 15.
    Ontario CC (2017) Cancer Care Ontario. Reg. Cancer Programs, In https://www.cancercareontario.ca/en/cancer-care-ontario/programs/regional-cancer-programs. Accessed 1 Aug 2017Google Scholar
  16. 16.
    Morgan DL (1996) Focus groups. Annu Rev Sociol 22:129–152.  https://doi.org/10.1146/annurev.soc.22.1.129 CrossRefGoogle Scholar
  17. 17.
    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res PsycholGoogle Scholar
  18. 18.
    Sparkes AC, Smith B (2014) Qualitative research methods in sport, exercise and health: from process to product, 1st edn. Routledge, New YorkGoogle Scholar
  19. 19.
    Faulkner G, Biddle S (2001) Exercise and mental health: it’s just not psychology! J Sports Sci 19:433–444.  https://doi.org/10.1080/026404101300149384 CrossRefPubMedGoogle Scholar
  20. 20.
    Coffey A, Atkinson P (1996) Making sense of qualitative data: complementary research strategies. Sage Publications, Thousand OaksGoogle Scholar
  21. 21.
    Green LW, Kreuter MW (2005) Health program planning: an educational and ecological approach, 4th edition. McGraw-Hill, New YorkGoogle Scholar
  22. 22.
    Din NU, Moore GF, Murphy S, Wilkinson C, Williams NH (2015) Health professionals’ perspectives on exercise referral and physical activity promotion in primary care: findings from a process evaluation of the National Exercise Referral Scheme in Wales. Health Educ J 74:743–757.  https://doi.org/10.1177/0017896914559785 CrossRefPubMedGoogle Scholar
  23. 23.
    Roundtree AK, Giordano SH, Price A, Suarez-Almazor ME (2011) Problems in transition and quality of care: perspectives of breast cancer survivors. Support Care Cancer 19:1921–1929.  https://doi.org/10.1007/s00520-010-1031-6 CrossRefPubMedGoogle Scholar
  24. 24.
    Brunet J, Taran S, Burke S, Sabiston CM (2013) A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer. Disabil Rehabil 35:2038–2045.  https://doi.org/10.3109/09638288.2013.802378 CrossRefPubMedGoogle Scholar
  25. 25.
    O’Brien MW, Shields CA, Oh PI, Fowles JR (2017) Health care provider confidence and exercise prescription practices of exercise is medicine Canada workshop attendees. Appl Physiol Nutr Metab 42:384–390.  https://doi.org/10.1139/apnm-2016-0413 CrossRefPubMedGoogle Scholar
  26. 26.
    Stake R (1994) Case Studies. In: Denzin N, Lincoln Y (eds) . Handb. Qual. Res. Sage, Thousand Oaks, pp 273–285Google Scholar
  27. 27.
    Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T, The Exercise for People With Cancer Guideline Development Group (2017) Exercise for people with cancer: a clinical practice guideline. Curr Oncol 24(1):40Google Scholar
  28. 28.
    Thornton JS, Frémont P, Khan K, Poirier P, Fowles J, Wells GD, Frankovich RJ (2016) Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise. Medicine 50:1–6.  https://doi.org/10.1136/bjsports-2016-096291 Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Angela J. Fong
    • 1
    • 2
  • Guy Faulkner
    • 3
  • Jennifer M. Jones
    • 4
  • Catherine M. Sabiston
    • 1
  1. 1.Faculty of Kinesiology and Physical EducationUniversity of TorontoTorontoCanada
  2. 2.School of Kinesiology and Health StudiesQueen’s UniversityKingstonCanada
  3. 3.School of KinesiologyUniversity of British ColumbiaVancouverCanada
  4. 4.Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer CentreUniversity Health NetworkTorontoCanada

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