Co-designing a primary care physiotherapist-led cancer rehabilitation intervention for people with metastatic breast cancer using a World Café approach

Objective: International guidelines recommend exercise-based rehabilitation in advanced cancer, however planning and implementation of rehabilitation is complex. Through engagement with people with metastatic breast cancer, clinical and academic physiotherapists, multidisciplinary team members and health service managers, we explored the intervention elements and the implementation planning of a primary care, exercise-based cancer rehabilitation intervention. Design setting and participants: Using a World Café and interpretive description design, we held two workshops. In workshop one (n = 9), the Template for Intervention Description and Replication checklist was used to identify intervention components. In workshop two (n = 23), the Practical, Robust Implementation and Sustainability Model guided implementation planning. Written data were collected using whiteboards. Discussions were audio-recorded, transcribed and analysed by two authors. Results: Workshop one highlighted the need for physiotherapists with oncology training to deliver individually-tailored, primary care-based interventions. Workshop two added that the role of physiotherapists with specialist oncology training would be to coordinate the delivery of adaptable interventions in an integrated manner, across care settings to respond to evolving needs of people with metastatic breast cancer, which include managing disease symptoms and treatment side-effects, and improving and maintaining quality of life and independence. Key implementation elements recommended include: evidence-based assessment and treatment; careful monitoring of patient and service outcomes; appropriate governance structures; service sustainability through ongoing training and supervision of physiotherapists, and oncologist support. Conclusions: A primary care, exercise-based cancer rehabilitation intervention requires physiotherapists with specialist oncology training to coordinate and provide an adaptable, integrated interventions that respond to needs of people with metastatic breast cancer. Contribution of the Paper: • We have described the essential intervention elements and implementation planning of a primary care exercise-based cancer rehabilitation intervention to decrease symptom burden and increase quality of life for people with metastatic breast cancer through engagement with a wide variety of relevant stakeholders. • Novel findings included support for physiotherapists with specialist oncology training to deliver and coordinate the delivery of adaptable interventions in an integrated manner across care settings to respond to the evolving needs of people with metastatic breast cancer. These should include the following implementation elements: evidence-based assessment and treatment; careful monitoring of patient and service outcomes; appropriate governance structures; service sustainability through ongoing training and supervision of physiotherapists and oncologist support.