JMIR Publications

ABSTRACT

Background:

Over 80% of breast cancer survivors do not meet recommended levels of exercise, and <50% of healthcare providers promote exercise as a part of survivorship care. Shared decision-making may enhance decisions about exercise engagement and potential referrals to rehabilitation or exercise programs.

Objective:

To evaluate the 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 healthcare providers who primarily treat such survivors.

Methods:

We conducted a cross-sectional online survey among U.S. breast cancer survivors and healthcare providers. Participants were female breast cancer survivors aged ≥35 years who self-reported not meeting guideline-recommended exercise levels, and healthcare providers who had cared for breast cancer survivors within the prior 12 months and reported below-average guideline adherence among their patients. Respondents reviewed a paper-draft of a web-based clinical decision support tool designed to support individualized exercise discussions and prescriptions based on women's individual, clinical, and contextual characteristics. Validated instruments assessed perceived usefulness, potential uses (e.g., counseling and referral), preferred timing of access within clinical encounters, and preferences for tool characteristics (e.g., inputs, outputs, and health outcomes).

Results:

The analytic sample comprised 26 breast cancer survivors and 69 healthcare providers. The median (IQR) age of breast cancer survivors was 48 (37-65) years. Providers included patient navigators/social workers/nurses (42.0%), breast oncologists (18.8%), and occupational/physical therapists (17.4%). Over 80% of providers (89.9%, 95% CI: 80.2-95.8%) and breast cancer survivors (88.5%, 95% CI: 69.8-97.6%) found the tool useful, and 85.5% (95% CI: 75.0-92.8%) of providers and 84.6% (65.1-95.6%) of survivors agreed the tool would increase their confidence to discuss exercise in a clinical setting. Survivors also favored accessing the tool individually before appointments, although this was less favorable to providers. Both groups agreed that individual characteristics such as treatment history and readiness to exercise should be included as tool inputs. Improved quality of life and lower treatment side effects were highly endorsed exercise benefits to be communicated as tool outputs.

Conclusions:

The prototype tool was well-received, with high agreement on individual characteristics to consider and clinical benefits of exercise to communicate. These findings will guide the refinement, implementation, and dissemination of the tool for an understudied population of breast cancer survivors.