A qualitative analysis of oncology clinicians’ perceptions and barriers for physical activity counseling in breast cancer survivors
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.
To examine factors affecting PA counseling in clinicians and inform future strategies.
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.
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.
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.
KeywordsBreast cancer Physical activity Exercise Health care providers Knowledge translation
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.
Conceptualization AF, CS; methodology AF, GF, JJ, CS; analysis AF, CS; initial draft of manuscript AF; and revisions AF, GF, JJ, CS.
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.
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 was obtained from all individual participants included in the study.
- 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
- 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.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.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
- 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/10.1037/0278-6126.96.36.199 CrossRefPubMedGoogle Scholar
- 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.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
- 14.Guba E, Lincoln Y (1994) Competing paradigms in qualitative research. Hanb. Qual Res 105:163–194Google Scholar
- 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
- 17.Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res PsycholGoogle Scholar
- 18.Sparkes AC, Smith B (2014) Qualitative research methods in sport, exercise and health: from process to product, 1st edn. Routledge, New YorkGoogle Scholar
- 20.Coffey A, Atkinson P (1996) Making sense of qualitative data: complementary research strategies. Sage Publications, Thousand OaksGoogle Scholar
- 21.Green LW, Kreuter MW (2005) Health program planning: an educational and ecological approach, 4th edition. McGraw-Hill, New YorkGoogle Scholar
- 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
- 26.Stake R (1994) Case Studies. In: Denzin N, Lincoln Y (eds) . Handb. Qual. Res. Sage, Thousand Oaks, pp 273–285Google Scholar
- 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.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