Developing an integrated rehabilitation model for thoracic cancer services: views of patients, informal carers and clinicians

Our plain-English summary of Developing an integrated rehabilitation model for thoracic cancer services: views of patients, informal carers and clinicians, by J. Bayly, B.M. Edwards, N. Peat, et al (Pilot and Feasibility Studies, 2018).

The study

• Authors: J. Bayly, B.M. Edwards, N. Peat, G. Warwick, I.M. Hennig, A. Arora, A. Wilcock, I.J. Higginson, M. Maddocks
• Journal: Pilot and Feasibility Studies
• Published: 2018;4:160
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Access to rehabilitation to prevent disability and optimise function is recommended for patients with cancer, including following cancer diagnosis. Models to integrate rehabilitation within oncology services as cancer treatment commences are required, but must be informed by those they are intended to support. We aimed to identify views of patients, carers and clinicians to develop and refine a rehabilitation model to be tested in a feasibility trial for people newly diagnosed with lung cancer or mesothelioma.

Methods: We conducted a focus group study with people affected by lung cancer or mesothelioma, their carers and clinicians providing their care to identify priorities for rehabilitation in this period. We sought views on core intervention components, processes and outcomes and integration with oncology services. Data were analysed using thematic analysis.

Results: Fifteen clinicians (oncologists, nurse specialists, physiotherapists and occupational therapists), nine patients and five carers participated. A proposed outline rehabilitation model was perceived as highly relevant for this population. Participants recommended prompt and brief rehabilitation input, delivered whilst people attend for hospital appointments or at home to maximise accessibility and acceptability. Participants recognised variation in need and all prioritised tailored support for symptom self-management, daily activities and the involvement of carers. Clinicians also prioritised achieving fitness for oncology treatment. Patients and carers prioritised a sensitive manner of approach, positivity and giving hope for the future. Participant's recommendations for outcome measurement related to confidence in usual daily activities, symptom control and oncology treatment completion rates over objective measures of cardiorespiratory fitness.

Conclusion: The importance of providing tailored rehabilitation around the time of diagnosis for people with lung cancer or mesothelioma was affirmed by all participants. The refined model of rehabilitation recommended for testing in a feasibility trial is flexible, tailored and short-term. It aims to support people to self-manage symptoms, tolerate cancer treatments and to remain active and independent in daily life. It is delivered alongside scheduled hospital appointments or at home by an expert practitioner sensitive to the psycho-social sequelae that follow a diagnosis of thoracic cancer.

In plain English

This UK qualitative study used focus groups to help design a rehabilitation programme for people newly diagnosed with lung cancer or mesothelioma, ahead of a planned feasibility trial. Between January and September 2017, 29 people took part in eight focus groups at three centres, two in London and one in the Midlands: 15 clinicians, nine patients (six with lung cancer, three with mesothelioma) and five informal carers. The study did not examine asbestos exposure. Patients and carers mainly wanted help getting on with normal life. Clinicians also stressed getting patients fit enough for cancer treatment. All participants most strongly wanted a flexible service fitted around hospital appointments, or delivered at home. Participants did not consider objective fitness measures useful for this varied group. Clinicians suggested including patients having surgery. The authors concluded that the refined model should be flexible, tailored and short-term. As limitations, they noted that recruited patients may have been fitter than others, and that some groups were very small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Qualitative focus group study with an action-focused pragmatic design, analysed using thematic analysis, as part of developing an intervention for a future randomised feasibility trial
• Who was studied: 29 participants in eight focus groups: 15 clinicians, 9 patients (6 lung cancer, 3 mesothelioma) and 5 informal carers, recruited January to September 2017 at three UK centres (two in London, one in the Midlands)
• Exposure: No asbestos or other environmental exposure was studied. Participants discussed a proposed outline rehabilitation model for people newly diagnosed with thoracic cancer (any primary lung cancer or pleural mesothelioma)
• Main results:
  • Patients and carers said their main concern after diagnosis was to get on with normal life
  • Clinicians emphasised optimising physical fitness for oncology treatment, saying this could expand treatment options and increase completion rates
  • The strongest message from all participants was for a flexible rehabilitation service integrated with scheduled hospital appointments; where travel was burdensome, home was the preferred location
  • Clinicians felt the proposed three contacts were appropriate
  • Participants did not consider objective fitness measures useful in this broad population. They recommended patient-reported measures, including confidence in daily activities and symptom management
  • Clinical participants said patients having surgery would also benefit, so the planned trial eligibility was broadened beyond inoperable disease
• The authors' conclusion: The authors concluded that the refined rehabilitation model recommended for feasibility testing is flexible, tailored and short-term, delivered alongside hospital appointments or at home
• Limitations the authors state:
  • Only fitter patients interested in rehabilitation may have been recruited, and they may not represent the views of people who are more unwell
  • Some patient focus groups were very small (two groups of three participants and one of two), which potentially limited interaction between participants
  • Because of the study's pragmatic, action-oriented approach, the authors did not analyse latent themes or consider wider structural issues that may affect implementation and outcomes

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma.

Related studies

• Short-term integrated rehabilitation for people with newly diagnosed thoracic cancer: a multi-centre randomized controlled feasibility trial — J. Bayly, L. Fettes, et al. (2020)
• Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service — R. Bentley, A. Hussain, et al. (2013)
• Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis — J. Bayly, D. Wakefield, et al. (2018)
• Living with mesothelioma: a systematic review of mental health and well-being impacts and interventions for patients and their informal carers — V. Sherborne, S. Ejegi-Memeh, et al. (2024)
• Developing sustainable patient and public involvement in mesothelioma research: multi-method exploration with researchers, patients, carers, and patient organisations — A. Marcu, F. McGregor, et al. (2023)
• Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study — C. Olivier, J.M. Grosbois, et al. (2018)

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