User Perspectives on a Clinical Decision Tool to Support Individualized Exercise Prescriptions for Breast Cancer Survivors Not Meeting Exercise Guidelines: Cross-Sectional Survey

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: 89.9% of providers and 88.5% of survivors found tool useful

• Primary Outcome: Perceived usefulness of clinical decision tool

• Nnt Or Sensitivity: 85.5% of providers and 84.6% of survivors reported increased confidence to discuss exercise

• Confidence Interval: Providers: 95% CI 80.2%-95.8%; Survivors: 95% CI 69.8%-97.6%

Clinical Application

High acceptability suggests good implementation potential, though technical infrastructure requirements not specified Relevant to Australian cancer survivorship care; aligns with Cancer Australia guidelines for survivorship care planning and COSA exercise recommendations Breast cancer survivors not meeting exercise guidelines and their healthcare providers in oncology and rehabilitation settings

Abstract

BACKGROUND: More than 80% of breast cancer survivors do not meet the recommended levels of exercise, and <50% of health care providers promote exercise as part of survivorship care. Patient-provider communication may enhance exercise engagement by increasing patients' understanding of exercise benefits and linking patients to resources, such as rehabilitation and exercise programs. OBJECTIVE: This study aimed to explore perspectives on a novel clinical decision tool designed to support individualized exercise discussions and prescriptions among breast cancer survivors who do not meet exercise guidelines and health care providers who primarily treat such survivors. METHODS: We conducted a cross-sectional online survey among US breast cancer survivors and health care providers. Participants were (1) female breast cancer survivors aged ≥35 years engaging in ≤150 minutes/week of moderate-intensity aerobic exercise or ≤2 days/week of muscle-strengthening exercise and (2) health care providers who had cared for breast cancer survivors within the past 12 months and reported below-average guideline adherence among their patients. Respondents reviewed a paper draft of a web-based clinical decision prototype tool for supporting individualized exercise discussions and prescriptions based on patients' demographic, clinical, and contextual characteristics. We assessed perceived usefulness, potential uses (eg, counseling), preferred timing of access within clinical encounters, and preferences for tool characteristics (inputs/outputs). RESULTS: The analytic sample comprised 26 breast cancer survivors and 69 health care providers. The survivors' median age was 48 (IQR 37-65) years. Providers included patient navigators/social workers/nurses (29/69, 42.0%), breast oncologists (13/69, 18.8%), and occupational/physical therapists (12/69, 17.4%). The majority of providers (62/69, 89.9%, 95% CI 80.2%-95.8%) and survivors (23/26, 88.5%, 95% CI 69.8%-97.6%) reported that they would find the tool useful. Similarly, 85.5% of providers (59/69, 95% CI 75.0%-92.8%) and 84.6% of survivors (22/26, 95% CI 65.1%-95.6%) reported that the tool would increase their confidence to discuss exercise in a clinical setting. Both groups preferred that survivors access the tool with staff after a medical appointment (survivors: 20/26, 76.9%, 95% CI 56.4%-91.0%; providers: 58/67, 86.6%, 95% CI 76.0%-93.7%). Both groups also endorsed treatment history and readiness to exercise to consider as key inputs and improved quality of life and reduced treatment-related side effects as exercise benefits to communicate as tool outputs. CONCLUSIONS: The prototype tool concept was well received, with high endorsement of individual characteristics to consider and clinical benefits of exercise to communicate. Findings will inform refinement of the tool and future implementation testing in an understudied population of breast cancer survivors.