Barriers to accessing cancer services for adults with physical disabilities in England and Wales: an interview-based study.

OBJECTIVES: The aim of this study was to explore the barriers to accessing cancer services faced by adults with pre-existing physical disabilities. DESIGN: Cross-sectional, exploratory qualitative study. Data were collected by semistructured interviews and analysed thematically. SETTING: Participants were recruited through statutory and third sector organisations in England and Wales between October 2017 and October 2018. PARTICIPANTS: 18 people with a diagnosis of cancer and a pre-existing physical disability. RESULTS: The findings illustrate that people with physical disabilities in England and Wales face a variety of barriers to accessing cancer services. The overall theme that emerged was that participants experienced a lack of attitudinal and institutional preparation both from healthcare professionals and healthcare facilities. This overall theme is illustrated through three subthemes: lack of acknowledgment of disability, unseeing disability and physical inaccessibility. CONCLUSIONS: As the population ages and increasing numbers of people live with cancer and disability, it is important to develop knowledge to respond to the needs of this population. The mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible and offered in a respectful manner. It is important that healthcare professionals work towards inclusive healthcare provision, enabling the utilisation of services by all. Necessary steps to be taken include better communication between the various professionals and across the different teams involved in patients' care, raising awareness of how physical disability can affect or interact with cancer-related treatment and creating more accessible physical environments.

Realist evaluation of cancer rehabilitation services in South Wales (REEACaRS): a mixed methods study protocol.

INTRODUCTION: Long-term and late effects of cancer treatments can cause functional limitations and reduce quality of life. Cancer rehabilitation services, which can comprise physical exercise, psychological support and educational interventions depending on the individual's needs, have been found to have a positive effect on health-related quality of life worldwide. However, accessibility or the lack of awareness on available help can act as barriers and influence the uptake of services, resulting in people having unmet rehabilitation needs. In Wales, UK, 41% of people, who have had health and social care needs resulting from cancer and its treatments, reported that they did not receive care when needed. The reason for this lack of support has not yet been fully investigated. The aim of this study is to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms in South Wales, UK, specifically addressing barriers, facilitators and costs. METHODS AND ANALYSIS: Realist evaluation, which explains for whom a service works in what circumstances and how through context-mechanism-outcome pattern conjunctions, will be used in three phases to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms. Phase 1 will be secondary analysis of a cancer rehabilitation database from a local Health Board to give context to who are accessing rehabilitation. Phase 2 will be thematic analysis of face-to-face, semistructured rehabilitation participant (n=20) and healthcare professional (n=20) interviews to explore the mechanisms of how cancer rehabilitation works. Phase 3 will be two case studies and cost-consequences analysis of cancer rehabilitation services. ETHICS AND DISSEMINATION: This study received favourable ethical opinion from London South-East Research Ethics Committee (17/LO/2123) in December 2017. This project is part of the author's PhD thesis and it is expected that the findings will be disseminated in academic journals and at local and international conferences.

Understanding the importance of therapeutic relationships in the development of self-management behaviours during cancer rehabilitation: a qualitative research protocol.

INTRODUCTION: Cancer is a growing health, social and economic problem. 1 in 3 people in the UK will develop cancer in their lifetime. With survival rates rising to over 50%, the long-term needs of cancer survivors are of growing importance. Cancer rehabilitation is tailored to address the physical or psychosocial decline in ability to engage in daily activities. Its use is supported by high-quality international, multicentre research. Incorporating strategies for self-management behaviour development into rehabilitation can prepare individuals for cancer survivorship. However, healthcare professionals will need to adjust their therapeutic interactions accordingly. Research is yet to clarify the impact of the therapeutic relationship on rehabilitation outcomes in cancer. This study aims to explore the impact of therapeutic relationships on self-management behaviours after cancer. METHODS AND ANALYSIS: This qualitative study aims to understand cancer rehabilitation participants' beliefs regarding the importance of therapeutic relationships in developing self-management behaviours. A sample representative of a local cancer rehabilitation cohort will be asked to complete a semistructured interview to identify their perspectives on the importance of therapeutic relationships in cancer rehabilitation. Data obtained from the interviews will be analysed, coded and entered into a Delphi questionnaire for circulation to a local cancer rehabilitation population to determine if the views expressed by the interviewees are supported by group consensus. ETHICS AND DISSEMINATION: This study was approved by Wales Research Ethics Committee 6 (15/WA/0331) in April 2016. Findings will be disseminated through the first author's doctoral thesis; peer-reviewed journals; local, national and international conference presentations; and public events involving research participants and the general public.

Addressing the employment-related needs of cancer survivors.

BACKGROUND: Increasingly, people diagnosed with cancer are surviving and continuing to participate in the work force. This trend brings with it new issues regarding survivors' employment-related needs. OBJECTIVE: The research team's objective is to explore cancer survivors' employment-related needs and supports with the ultimate goal of developing a training intervention for them. METHODS: Data were collected via an online survey. This article reports on the findings from the pilot stage of the study, which included 32 respondents. RESULTS: Many cancer survivors experience cancer symptoms at work, but do not tend to seek reasonable accommodations. Levels of awareness of possible programmatic and legal supports are low. Respondents reported that neither employers nor medical practitioners are primary sources of information regarding their individual employment-related concerns. Instead, they relied on general information from cancer advocacy organizations. CONCLUSIONS: Survivors, employers, and practitioners who treat cancer patients could benefit from training resources about how survivors might address their employment-related needs.