Bridging the gap between attitudes and action: Opportunities for the cancer care workforce to support exercise counselling and referral

      Background: The majority of the cancer care workforce have favourable attitudes and opinions of exercise for cancer patients, and report that exercise is safe and beneficial; nevertheless, insufficient time and uncertainty of what to recommend are reported as common barriers to discussing and/or counselling their patients about exercise. The limited research about cancer care clinician's communication with their patients about exercise suggests that a timely discussion about regular exercise can be reassuring, informative and motivational for patients. This study aimed to 1) understand the factors impacting the implementation for exercise communication and referral, and 2) explore and initiate co-ordinated and integrated clinical approaches to exercise communication and referral.
      Methods: Seven focus groups were conducted with cancer care clinicians and practitioners (N=53) (i.e., oncologists, haematologists specialising in cancer, oncology nurses, physiotherapists, exercise physiologists, social workers and psychologists) working with cancer patients throughout Sydney, Australia. In addition, a sub-sample of participants (n=9) attended a half-day workshop focused on identifying best practice approaches for moving forward. Thematic content analysis was utilised to analyse the data.
      Results: Two overarching themes, and associated subthemes, emerged from the data: 1) Factors impacting the knowledge-to-action gap, highlights the challenges and barriers clinicians and practitioners face in implementing exercise counselling and a referral pathway; inclusive of the funding structure, current referral process (i.e., only available via general practitioner/Medicare), lack of exercise specific knowledge and education to confidently advice/counsel patients, limited access and opportunity for professional development/training specific to exercise for cancer care, and 2) Recommendations for a consistent and efficient way forward, describes an action-orientated exercise counselling and referral pathway approach; inclusive of an oncologist-initiated brief communication exchange, distribution of a variety of cancer-specific, tailored exercise resources for patients (e.g., videos, online, hard copy), access to exercise physiologists with cancer care expertise, initial exercise consultation prompted by exercise physiologist.
      Discussion: This study has identified important factors influencing exercise counselling and referral by the cancer care workforce, and potential approaches for incorporating exercise into standard cancer care. A model for an exercise referral pathway is provided to guide implementation, inclusive of oncologist-initiated communication exchange, relevant resources, and access to exercise practitioners with cancer expertise. Future testing is required to determine feasibility and practicality of these approaches.
      Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.