How to implement a physical activity program in primary care among cancer survivors: barriers and facilitators from the perspective of the GP and practice nurse

Famke Huizinga, Nico-Derk Lodewijk Westerink, Annette J. Berendsen, Annemiek M.e. Walenkamp, Marjolein Y. Berger, Daan Brandenbarg

Background:

Lifestyle receives increasing attention in primary care of cancer survivors. However, little is known about how to successfully implement lifestyle programs in general practice, and the related barriers and facilitators.

Research questions:

What are the barriers and facilitators on the implementation of a physical activity (PA) program for cancer survivors in general practice from the perspective of general practitioners (GPs) and practice nurses?

Method:

A qualitative study using data from multiple sources collected during the implementation of the PA program: field notes, interviews with GPs, and a focus-group with participating practice nurses. We used thematic analyses proposed by Braun & Clarke, where two researchers performed inductive coding. All data was collected in Atlas.ti.

Results:

We collected field notes of all the GP practices that initially participated (n=20), and interviewed 3 GPs and 7 practice nurses from 6 GP practices who continued participation, and 2 GPs and 2 practice nurses from 3 GP practices who quitted participation. Barriers to implementation were organizational issues, low commitment of the GP and practice nurse, negative experiences with participating patients, and an undefined patient group. Facilitators were collaboration within the team, a motivated practice nurse, and experienced patient benefits. Strategies to address the barriers were embedding consultations within regular clinical practice, combining consultations, enabling practice nurses to share their experiences with peers, support to define patient group, and technical support for digital problems.

Conclusions:

The most important barriers and facilitators from GPs’ and practice nurses’ perspective on the implementation of a PA program for cancer survivors in GP practice relate to the organization domain and patient experiences. The results of this qualitative study can be used to improve future implementation of lifestyle programs in primary care.

Points for discussion:

Is primary care (i.e. general practice) suitable for implementation of lifestyle programs for cancer survivors or should we think at other alternatives?

#53