Lung cancer survivors’ views on telerehabilitation following curative intent therapy: a formative qualitative study

• Published in: BMJ open Vol. 13; no. 6; p. e073251
• Main Authors: Ha, Duc M, Nunnery, Mary A, Klocko, Robert P, Haverhals, Leah M, Bekelman, David B, New, Melissa L, Randhawa, Simran K, Stevens-Lapsley, Jennifer E, Studts, Jamie L, Prochazka, Allan V, Keith, Robert L
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 23-06-2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Cancer Survivors; Cancer therapies; Chronic obstructive pulmonary disease; Codes; Data analysis; Exercise; Fitness training programs; Health education; Health literacy; Humans; Internet access; Intervention; Interviews; Lung; Lung cancer; Lung Neoplasms - therapy; Medical screening; Objectives; Oncology; Physical fitness; QUALITATIVE RESEARCH; Radiation; Rehabilitation; REHABILITATION MEDICINE; Sleep apnea; Teams; Telemedicine; Telerehabilitation - methods; Thoracic surgery; Veterans; United States > US; Telemedicine; REHABILITATION MEDICINE; QUALITATIVE RESEARCH
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-073251

ObjectivesTo inform personalised home-based rehabilitation interventions, we sought to gain in-depth understanding of lung cancer survivors’ (1) attitudes and perceived self-efficacy towards telemedicine; (2) knowledge of the benefits of rehabilitation and exercise training; (3) perceived facilitators and preferences for telerehabilitation; and (4) health goals following curative intent therapy.DesignWe conducted semi-structured interviews guided by Bandura’s Social Cognitive Theory and used directed content analysis to identify salient themes.SettingOne USA Veterans Affairs Medical Center.ParticipantsWe enrolled 20 stage I–IIIA lung cancer survivors who completed curative intent therapy in the prior 1–6 months. Eighty-five percent of participants had prior experience with telemedicine, but none with telerehabilitation or rehabilitation for lung cancer.ResultsParticipants viewed telemedicine as convenient, however impersonal and technologically challenging, with most reporting low self-efficacy in their ability to use technology. Most reported little to no knowledge of the potential benefits of specific exercise training regimens, including those directed towards reducing dyspnoea, fatigue or falls. If they were to design their own telerehabilitation programme, participants had a predominant preference for live and one-on-one interaction with a therapist, to enhance therapeutic relationship and ensure correct learning of the training techniques. Most participants had trouble stating their explicit health goals, with many having questions or concerns about their lung cancer status. Some wanted better control of symptoms and functional challenges or engage in healthful behaviours.ConclusionsFeatures of telerehabilitation interventions for lung cancer survivors following curative intent therapy may need to include strategies to improve self-efficacy and skills with telemedicine. Education to improve knowledge of the benefits of rehabilitation and exercise training, with alignment to patient-formulated goals, may increase uptake. Exercise training with live and one-on-one therapist interaction may enhance learning, adherence, and completion. Future work should determine how to incorporate these features into telerehabilitation.