Provider physical activity referrals are recommended for cancer survivors, though barriers exist to clinical system integration. To develop and test ActivityChoice, an electronic referral (eReferral) clinic implementation program referring cancer survivors to physical activity programs of their choice. In Phase 1, we conducted semi-structured interviews with Cancer Center clinicians (n = 4) and cancer-focused physical activity program leaders (n = 3) assessing adaptations needed to implement an eReferral previously designed for another context. In Phase 2, we pilot-tested clinician-delivered referrals to survivors in two 12-week Plan, Do, Study, Act (PDSA) cycles. We examined feasibility using descriptive statistics (clinicians' adoption and engagement, patient referrals, and physical activity program enrollment) and acceptability through semi-structured interviews with enrolled clinicians (n = 4) and referred patients (n = 9). ActivityChoice included a secure referral webform, text message/email referral confirmations, clinician training/booster sessions, visual reminders, and referrals to in-person or virtual group physical activity programs. Results for each PDSA cycle respectively included: 41% (n = 7) and 53% (n = 8) of clinicians adopted ActivityChoice; 18 and 36 patients were referred; 39% (n = 7) and 33% (n = 12) of patients enrolled in programs, and 30% (n = 4) and 14% (n = 5) of patients deferred enrollment. Patients and clinicians appreciated the referrals and choices. A printed handout describing both programs was added to the clinic workflow for Cycle 2, which yielded more referrals, but lower program enrollment rates. Clinic-based eReferrals to choices of physical activity programs were feasible and acceptable by clinicians and patients. Added clinic workflow support may facilitate referrals.
Keywords: Cancer; Implementation; Physical activity; Referrals; Survivorship.
Physical activity can improve the health, quality of life, and longevity among cancer survivors. Patients want to receive physical activity referrals and guidance from their cancer care team, but clinicians lack the knowledge, resources, time, and methods to counsel and refer their patients to community-based physical activity programs. One solution is to create a comprehensive electronic referral (eReferral) system giving cancer care clinicians the tools to support and refer their patients. We developed a simple eReferral that allows clinicians to refer patients to existing, evidence-based physical activity programs led by qualified exercise professions, LIVESTRONG at the YMCA (in-person) and Fit Cancer (virtual). We pilot tested the system with clinicians in two 12-week cycles. Clinicians were excited about the program and like the options they had to offer patients while providing suggestions on how we could better integrate it into their work environment. Patients appreciated the referral from their trusted cancer care clinician and appreciated choices of an in-person and virtual program to accommodate their preferences. To improve patient referrals and enrollment in physical activity programs, a more detailed printed handout that explains the benefits of physical activity in survivorship and describes each of the programs in detail may be helpful.
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