Implementation strategies for cancer rehabilitation in clinical practice: a Delphi study

Objective The purpose of this study was to identify implementation strategies and determine priorities for establishing a seamless cancer rehabilitation delivery system based on consensus among multidisciplinary stakeholders. Methods An online modified-Delphi study was conducted. A total of 100 stakeholders (healthcare professionals, researchers, cancer survivors, and members of patient support groups) with experience in cancer rehabilitation were invited. Participants selected the top three barriers to cancer rehabilitation in the first survey. In the second survey, the implementation strategy list was provided, and the effectiveness of each strategy was rated using a 4-point Likert scale. In the third survey, participants evaluated the impact and cost of successful implementation using a 4-point scale to determine priority. Results Valid responses were obtained from 85 participants for the first survey, 64 for the second survey, and 59 for the third survey. Consensus was reached on all 35 implementation strategies as effective measures (agreement rate for each item ranged from 70.3% to 98.4%). Fourteen items were judged very effective. The assessment of priority considering impact and cost indicated that reinforcing multidisciplinary collaboration and improving access to information were high priorities. Conclusions This study identified implementation strategies and priorities for cancer rehabilitation based on expert consensus. These findings demonstrate that improving inter- and intra- organizational processes is as crucial as institutional and structural enhancements. The identified strategies are expected to bridge the gap between evidence and clinical practice in Japan, contributing to the promotion of effective, continuous cancer rehabilitation delivery systems.