Lack of Successful Implementation of Cancer Rehabilitation Guidelines: A Mixed-methods Study Highlighting Need for Better Preconditions in Primary Care

Implementing cancer rehabilitation in primary care that addresses the physical, psychological, social, and existential consequences of cancer is considered important. AIM: To describe primary care practitioners' self-reported preconditions-including facilitators and barriers-related to cancer rehabilitation and physical activity, as well as their interest in responding to questions about cancer rehabilitation. METHODS: This convergent mixed-methods study collected self-reported quantitative questionnaire data using 0 to 10 scales (10 = maximum) from 229 primary care practitioners (104 rehabilitation practitioners and 125 healthcare center practitioners), and written qualitative data from a sub-sample of 120. RESULTS: Among rehabilitation practitioners, 20% provided some form of cancer rehabilitation and 70% prescribed physical activity to consulting cancer survivors. Corresponding figures for healthcare center practitioners were 10% and 15%, respectively. Both rehabilitation and healthcare center practitioners reported a median score of 0 (no knowledge) regarding physical activity advice for cancer survivors, and 95% of participants had not read cancer rehabilitation guidelines. Rehabilitation practitioners gave median ratings of 8 and 9 for the importance of providing cancer rehabilitation and physical activity advice, respectively, compared with 6 and 7 among healthcare center practitioners. Median ratings among rehabilitation practitioners were 3 for workplace preparedness and 3 for sufficient time for cancer rehabilitation, compared with 2 and 0 (no time at all) among healthcare center practitioners. Facilitators of the implementation were that providing cancer rehabilitation was considered important, and that practitioners were experienced in rehabilitation and physical activity counseling in non-cancer populations. To have committed and motivated co-workers facilitated a positive work culture for cancer rehabilitation. Primary barriers were the limited knowledge and skills and perceived unsatisfactory organizational preconditions, shaping an uncertainty on if primary care has any responsibility for cancer rehabilitation. Of the 168 rehabilitation practitioners invited, 104 (62%) were interested in answering questions regarding cancer rehabilitation. Among the 1055 invited healthcare center practitioners, 125 (12%) were interested. CONCLUSIONS: Given the limited preconditions for cancer rehabilitation and physical activity implementation, the described barriers and facilitators, and the varying interest among practitioners, educational interventions and support strategies tailored to both individuals and organizations appear necessary.