HOW PHYSICAL ACTIVITY CAN BE DISCUSSED IN CLINICAL SETTINGS WITH ONCOLOGY CARE PROVIDERS AND NON-CURATIVE CANCER PATIENTS

Abstract

Physical activity (PA) is an important component of a healthy lifestyle, with strong evidence demonstrating its benefits for individuals living with and beyond cancer, including those with non-curative cancer. Evidence shows that PA helps maintain quality of life (QOL), improve physical functioning, and enhance overall well-being. Despite this, PA remains underutilized in cancer care. One key factor is the role of oncology care providers (OCPs), who are trusted sources of information for patients but face challenges in consistently integrating PA discussions into clinical practice. This dissertation explored the clinical care context of PA conversations, understanding the current healthcare system, use of resources, and how patients, family/ friend caregivers, health decision makers, and OCPs perceive these discussions. To achieve this, this dissertation conducted three studies, with corresponding manuscripts. We conducted interviews to gain a deeper understanding of clinical appointments and to identify barriers and facilitators to PA conversations. We present these findings in two manuscripts: one focused on glioblastoma (GB) patients, OCPs, health decision-makers, and family/friend caregivers; the second study on OCPs of patients with non-curative cancer. We mapped these findings onto the Capability, Opportunity, Motivation-Behaviour (COM-B) model and then further refined them using the Theoretical Domains Framework (TDF) to create co-designed resources in the subsequent study. In the third manuscript, using a co-design approach this study embedded the Behaviour Change Wheel (BCW) to identify ways of making PA conversations more effective and efficient for both patients and OCPs. This process involved co-design workshops, during which participants collaborated with the research team to gather, analyze, and interpret data. Methods employed included storyboarding the clinical appointments to identify touchpoints where an OCP could discuss PA. Following this, this study developed workshop outputs into resources to support future integration into clinical care. Findings from this research emphasize the importance of the patient–provider relationship. Both patients and providers want PA conversations to happen but face systemic barriers such as limited appointment time and a lack of formal support. This work contributed to the design of two resources 1) a patient-facing information video for waiting rooms and 2) a prompting guide to support OCPs in having efficient, meaningful PA conversations. Overall, this dissertation offers valuable insights into the local health system context, with implications that extend to both local and national levels. The findings highlight multilevel factors, spanning individuals and the health system, that influence discussions about PA in clinical care for non-curative cancer patients. Importantly, OCPs are willing and motivated to engage in these discussions but need better systems to support them. Given the growing evidence base for PA in cancer care, these findings represent an important step toward embedding PA as a standard component of oncology practice.