Exploring what influences the uptake of cancer rehabilitation services: a realist informed mixed-methods study.

Objectives: To investigate how uptake of cancer rehabilitation services is affected by information provision and whether it is influenced by people's perception and attitudes towards rehabilitation interventions and therapies.

Design: This study followed a realist informed mixed-methods design. Descriptive secondary analysis of a cancer rehabilitation database containing information about number of people attending services, their diagnosis and sex and semi-structured interviews with people affected by cancer (PABC) and healthcare professionals (HCPs) were conducted.

Setting: Cancer rehabilitation services located in two cancer centres in South Wales, UK.

Participants: PABC who received care from any of the included cancer rehabilitation services. HCPs providing cancer rehabilitation at any of the included services.

Interventions: Exercise-based cancer rehabilitation, fatigue management, acupuncture and allied health professional support were provided as cancer rehabilitation.

Results: Twenty HCPs and 15 PABC were recruited for semi-structured interviews across the two services. The number of database records used for the secondary analysis ranged from 212 to 347 between 2014 and 2017. Based on descriptive analysis of these records and thematic analysis of HCPs' interviews, uptake of cancer rehabilitation services often fluctuated. This could be attributed to PABC reporting issues with information provision on available services. Based on PABC's accounts, they learnt about cancer rehabilitation in various ways, often by chance via word of mouth. Information provision was influenced by several issues including lack of consensus on what cancer rehabilitation means, the wider multidisciplinary team's (MDT) perception and knowledge on cancer rehabilitation, the prevailing medical model in healthcare and the lack of routine provision of services. The perception and attitude of PABC did not seem to inhibit uptake and information provision.

Conclusions: To modify these inhibiting issues, the education of the wider MDT regarding the aim, modalities and importance of cancer rehabilitation is crucial.