Survey Outlines Lung Cancer Survivors’ Views on Telerehabilitation

Telerehabilitation interventions for lung cancer survivors following curative intent therapy may need to include strategies to improve self-efficacy and telemedicine skills, according to new survey results published in BMJ Open.

“The number of lung cancer survivors eligible for curative intent therapy is expected to increase alongside efforts to improve lung cancer screening uptake, additional advances in diagnostic, and therapeutic modalities,” researchers explained.

However, following curative intent therapy, many survivors continue to experience disability and poor health-related quality of life. According to the authors, there is a great need for home-based approaches and interventions to improve these survivorship outcomes. Home-based interventions can be personalized, and increase uptake, adherence, and completion, they noted. One such intervention is telerehabilitation, although little is known about how lung cancer survivors view this approach.

To address this knowledge gap, the researchers carried out a formative qualitative study. Their survey assessed survivors’ views on:

• Attitudes and perceived self-efficacy toward telemedicine
• Knowledge of the benefits of rehabilitation and exercise training
• Perceived facilitators and preferences toward telerehabilitation
• Health goals following curative intent therapy

Participants were recruited from the Rocky Mountain Regional Veterans Affairs Medical Center between April and October 2022.

A total of 20 stage I-IIIA lung cancer survivors were included, all of whom had completed curative intent therapy within the prior 1 to 6 months. In the United States, 40% to 50% of lung cancers are diagnosed at stage I-IIIA and most of these patients are eligible for curative intent therapy, the authors wrote.

Eighty-five percent of participants had prior experience with telemedicine. None had prior experience with telerehabilitation or lung cancer rehabilitation.

Analyses revealed these findings:

• Telemedicine was viewed as convenient, but impersonal
• Lack of education on specific exercise training regimens
• Preference for live and one-on-one interaction with a therapist, when participants were asked about designing their own telerehabilitation program, “to enhance the therapeutic relationship and ensure correct learning of the training techniques”
• Difficulty explicitly stating health goals
• Wanting better control of symptoms and to engage in healthful behaviors

The median interview duration was around 37 (range, 19-46) minutes. Investigators used Bandura’s Social Cognitive Theory to guide the study design and analysis.

To increase uptake, they suggest improving education to enhance knowledge of the benefits of rehabilitation and exercise training that align with patient-formulated goals.

In addition, “exercise training with live and one-on-one therapist interaction may enhance learning, adherence, and completion,” they wrote—although more research is needed to determine how to incorporate these features into telerehabilitation.

The contrasting views on telemedicine reported are similar to previous results of qualitative studies, the authors noted.

The absence of subgroup comparisons by age and sex marks a limitation to the study. Researchers also did not inquire about specific socioenvironmental factors, which may influence perceptions of telerehabilitation. Most participants were male with significant cigarette smoking and chronic obstructive pulmonary disease, meaning results also may not be generalizable. Individuals were also recruited from a single US Veterans Affairs Medical Center.

“Women’s perspectives could reveal important health-related attitudes, knowledge, or behaviors not captured in our study. Last, we do not know the feasibility or acceptability of a telerehabilitation intervention in this population,” the authors concluded.

Reference

Ha DM, Nunnery MA, Klocko RP, et al. Lung cancer survivors’ views on telerehabilitation following curative intent therapy: a formative qualitative study. BMJ Open. Published online June 23, 2023. doi:10.1136/bmjopen-2023-073251