A qualitative study exploring the desired elements, potential benefits, barriers and facilitators of a physiotherapy-led exercise-based service in a primary care setting to improve the quality of life of people with metastatic breast cancer

Objective: Cancer rehabilitation interventions can improve quality of life (QOL) in people with metastatic breast cancer (PwMBC), but little is known on how to tailor cancer rehabilitation strategies in a primary care (primary care) setting. Using Focus Group Discussion (FGDs) including PwMBC and physiotherapists, this qualitative study aimed to explore the desired elements, potential benefits, barriers and facilitators of a proposed physiotherapy-led, exercise-based cancer rehabilitation service in a primary care setting to improve the QOL of PwMBC. Methods: We used a World Café approach guided by interpretative description qualitative methodology and the Braun and Clarke process. We included PwMBC and physiotherapists working in primary care, national and local acute oncology and palliative care services in three FGDs. All FGDs were transcribed and analysed inductively. The COnsolidated criteria for REporting Qualitative research checklist was used. Results: FGD1 (N = 13) comprised of physiotherapists working in primary care and national acute oncology care settings. FGD2 included PwMBC (N = 4). FGD3 (N = 4) included physiotherapists working in palliative and local acute care settings. Three themes were identified. 1. ‘Empowerment’ highlighted potential benefits and facilitators including the maintenance of overall health, a self-management approach, symptom management and maintaining independence. 2. ‘Social safety’ outlined elements of the proposed intervention including primary care setting, multi-disciplinary approach, appropriate resources and access to information. 3. ‘Trust’ suggested barriers including lack of: suitably trained therapists to provide intervention, bidirectional communication, shared care management and the importance of causing no harm. Conclusions: PwMBC are underrepresented in cancer rehabilitation and this research provides evidence supporting strategies and interventions to optimise rehabilitation of PwMBC. Contribution of the Paper: • There are unique barriers to providing cancer rehabilitation to patients with metastatic cancer outside of the acute hospital environment. • The perspectives and preferences of PwMBC and physiotherapists need to be considered for the successful implementation of in order for improvements in the management of PwMBC survivorship to be realised. • PwMBC and physiotherapists highlighted a need for all healthcare teams to work together in an integrated way to deliver the identified elements, benefits and facilitators of a primary care physiotherapy-led cancer rehabilitation service.