Medicine, Faculty of
Non UBC
Occupational Science and Occupational Therapy, Department of
Physical Therapy, Department of
DSpace
Healthcare 13 (7): 822 (2025)
Smith-Turchyn, Jenna
Farley, Christopher
Newman, Anastasia N. L.
Pannu, Jayden
Rochwerg, Bram
Mukherjee, Som D.
Beauchamp, Marla
Li, Linda C.
Mian, Hira
Kho, Michelle E.
Background/Objectives: Survivors of cancer have more than double the risk of developing sepsis compared to those with no history of cancer. Those who develop sepsis have lasting side effects reducing their physical function and quality of life. Rehabilitationrelated needs and barriers are unknown for individuals with cancer who have had sepsis. The aim of this study was to examine the rehabilitation-related experiences of patients with cancer and/or sepsis, their caregivers, and the healthcare team and the educational needs regarding the rehabilitation of patients with sepsis. Methods: We performed a qualitative descriptive study using interviews and focus groups for data generation. We included adults living in Canada who were English-speaking, currently or formerly diagnosed with cancer and/or sepsis, or a caregiver of someone with a current or past diagnosis of cancer and/or sepsis, or a healthcare professional working with this population. Two reviewers used NVivo software for data management and conducted a qualitative data analysis. Results: We included 30 study participants (nine patients, nine caregivers, 12 healthcare professionals; 15 for one-on-one interviews; 15 in the focus groups). We identified three overarching themes relating to rehabilitation: (1) the rehabilitation experience did not meet the patient’s care expectations; (2) barriers to rehabilitation exist on multiple levels; (3) there are important gaps in education on how to improve physical and psychosocial outcomes. We identified two themes related to educational resources: (1) the educational content provided must be specific and meaningful; (2) multi-modal resources are needed to suit diverse partner needs. Conclusions: We identified rehabilitation barriers related to healthcare settings, the pandemic, and workplace culture for those with cancer and sepsis. This study highlights the need to create diverse educational resources on rehabilitation for those with sepsis to improve outcomes and patient/caregiver satisfaction.
Academic Editor: Vasiliki EfstathiouReceived: 25 February 2025Revised: 28 March 2025Accepted: 2 April 2025Published: 4 April 2025Citation: Smith-Turchyn, J.;Farley, C.; Newman, A.N.L.; Pannu, J.;Rochwerg, B.; Mukherjee, S.D.;Beauchamp, M.; Li, L.C.; Mian, H.;Kho, M.E. A Qualitative StudyExploring the RehabilitationExperience of Individuals with aPrevious Diagnosis of Cancer and/orSepsis, Their Caregivers, and HealthProviders. Healthcare 2025, 13, 822.https://doi.org/10.3390/healthcare13070822Copyright: © 2025 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license(https://creativecommons.org/licenses/by/4.0/).ArticleA Qualitative Study Exploring the Rehabilitation Experience ofIndividuals with a Previous Diagnosis of Cancer and/or Sepsis,Their Caregivers, and Health ProvidersJenna Smith-Turchyn 1,*, Christopher Farley 1, Anastasia N. L. Newman 1 , Jayden Pannu 1, Bram Rochwerg 2,Som D. Mukherjee 3, Marla Beauchamp 1 , Linda C. Li 4 , Hira Mian 2 and Michelle E. Kho 11 School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada;farlec3@mcmaster.ca (C.F.); newmanan@mcmaster.ca (A.N.L.N.); pannuj9@mcmaster.ca (J.P.);beaucm1@mcmaster.ca (M.B.); khome@mcmaster.ca (M.E.K.)2 Department of Medicine, McMaster University, Hamilton, ON L8P 1H6, Canada;rochwerg@mcmaster.ca (B.R.); hira.mian@medportal.ca (H.M.)3 Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada; mukherjee@hhsc.ca4 Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;lli@arthritisresearch.ca* Correspondence: smithjf@mcmaster.caAbstract: Background/Objectives: Survivors of cancer have more than double the risk ofdeveloping sepsis compared to those with no history of cancer. Those who develop sepsishave lasting side effects reducing their physical function and quality of life. Rehabilitation-related needs and barriers are unknown for individuals with cancer who have had sepsis.The aim of this study was to examine the rehabilitation-related experiences of patients withcancer and/or sepsis, their caregivers, and the healthcare team and the educational needsregarding the rehabilitation of patients with sepsis. Methods: We performed a qualitativedescriptive study using interviews and focus groups for data generation. We includedadults living in Canada who were English-speaking, currently or formerly diagnosed withcancer and/or sepsis, or a caregiver of someone with a current or past diagnosis of cancerand/or sepsis, or a healthcare professional working with this population. Two reviewersused NVivo software for data management and conducted a qualitative data analysis.Results: We included 30 study participants (nine patients, nine caregivers, 12 healthcareprofessionals; 15 for one-on-one interviews; 15 in the focus groups). We identified threeoverarching themes relating to rehabilitation: (1) the rehabilitation experience did notmeet the patient’s care expectations; (2) barriers to rehabilitation exist on multiple levels;(3) there are important gaps in education on how to improve physical and psychosocialoutcomes. We identified two themes related to educational resources: (1) the educationalcontent provided must be specific and meaningful; (2) multi-modal resources are neededto suit diverse partner needs. Conclusions: We identified rehabilitation barriers related tohealthcare settings, the pandemic, and workplace culture for those with cancer and sepsis.This study highlights the need to create diverse educational resources on rehabilitation forthose with sepsis to improve outcomes and patient/caregiver satisfaction.Keywords: chronic illness experience; health promotion; cancer; sepsis; rehabilitation;patient education1. IntroductionSepsis is broadly defined as a life-threatening illness caused by a dysregulated immuneresponse to infection [1,2]. Each year, sepsis affects approximately 49 million peopleHealthcare 2025, 13, 822 https://doi.org/10.3390/healthcare13070822Healthcare 2025, 13, 822 2 of 17worldwide, with approximately 38 million individuals surviving hospitalization for sepsiseach year [3]. However, many of these individuals are re-hospitalized or die within 90 daysof discharge, posing a significant healthcare problem [4]. The lack of adequate rehabilitationexacerbates this issue.More than 20% of sepsis hospitalizations are cancer-related [1,2]. Cancer is a commoncondition in adults; two in five Canadian adults will be diagnosed with cancer [5]. Survivorsof cancer have more than double the risk of developing sepsis over their lifetime comparedto those with no history of cancer [1,2]. This increased risk of sepsis in those with ahistory of cancer is often multifactorial and may be related to cancer treatments (such aschemotherapy, targeted therapies, radiation and/or steroids, which can all suppress theimmune system) and procedures (e.g., surgery, central venous access insertion, biopsies)used to treat and diagnose cancer [1,2]. Sepsis is associated with 5% of all cancer deaths [2].Approximately 50% of those surviving sepsis will develop post-sepsis syndrome,defined as long-term physical, psychological, or cognitive medical issues [6–10]. Commonsymptoms persisting for long periods of time after hospital discharge include fatigue,shortness of breath, muscle and joint pain, difficulty sleeping, poor appetite, depression,anxiety, difficulty concentrating, and post-traumatic stress disorder [6,11]. These sideeffects may lead to reduced physical function and an inability to return to work [12,13].Individuals with cancer also experience prolonged symptoms, for years and decades aftercancer treatments have ended or their cancer has been treated into remission [14–17]. Thesesymptoms are similar to post-sepsis syndrome and can include reduced joint range ofmotion, reduced strength, fatigue, reduced mobility, decreased physical function, anxiety,depression, poor quality of life, and frailty [16,17]. Those with a combined diagnosisof sepsis and cancer have increased risk of mortality and increased risk of living withsubstantial physical and psychosocial sequalae [1,18].Rehabilitation interventions aim to optimize function and reduce disability and caninclude components of physical therapy, occupational therapy, speech language pathology,nutrition, and psychosocial therapies, which can be provided in acute hospital and outpa-tient settings [19]. Regular rehabilitation can minimize the physical and psychosocial effectsof cancer [20–24] and sepsis [25–27], thereby improving the quality of life for survivorsof both conditions. Despite this, studies examining the lived experience and satisfactionof survivors of sepsis or cancer regarding rehabilitation both during acute care and posthospital discharge have been conducted [28–30] but remain limited, highlighting the needfor continued research. One study examined the suitability, extent, and satisfaction withrehabilitation in the year following a hospital admission for acute sepsis and found thatpatients believed that rehabilitation should begin earlier during their hospital stay, be moretailored to their specific physical outcomes, and include more detailed education [28].While these studies provide preliminary evidence, more data are needed, especiallyregarding individuals with a history of both sepsis and cancer. Currently, there are nostudies looking at the rehabilitation needs of individuals living with a previous diagnosis ofboth conditions. This information is important, because the severity of side effects and needfor rehabilitation in those with sepsis and cancer is expected to be worse than the severityof one condition alone [31]. Further, the time when rehabilitation services are started (i.e., inthe acute ICU setting versus in inpatients wards) is variable between geographical locations.Therefore, improving our knowledge on the bidirectional interaction of these conditions andthe need for rehabilitation will help to improve the rehabilitation interventions providedto this population [18,31]. Therefore, the overall goal of this study was to examine therehabilitation-related experiences of individuals with a history of sepsis and cancer andto explore the educational needs of sepsis survivors as well as of their caregivers andthe healthcare team. To achieve this goal, we had two research objectives: (1) examineHealthcare 2025, 13, 822 3 of 17the rehabilitation-related experiences and barriers to rehabilitation for individuals with ahistory of sepsis and cancer, their caregivers, and the healthcare team; (2) explore patient,caregiver, and health professional needs for educational resources related to rehabilitationto improve the experiences of those with sepsis.2. Materials and Methods2.1. Study DesignWe used a qualitative study design to achieve the research objectives. We performed aqualitative descriptive study [32,33] using interviews and focus groups. Qualitative descrip-tive studies are used when the goal is to provide a detailed description of a phenomenonor experience, and they prioritize the detailed description of an experience, rather thanseeking to interpret it in depth [32,33]. They are particularly useful when little is known ona topic and provide insight for an initial understanding [32,33]. The Hamilton IntegratedResearch Ethics Board approved this study (ID: 15072), and we ensured written informedconsent from all participants. We report the findings of this study in accordance with theCOnsolidated criteria for REporting Qualitative research (COREQ) checklist for interviewsand focus groups (see Supplementary File S1) [34].We undertook this study as part of the larger “ICaRe” project, which is an experience-based co-design (EBCD) project aiming to explore the Intersection of Cancer, sepsis, and frailty,and improve informational/educational tools describing the potential benefit of Rehabilitationservices for these populations. EBCD is an approach involving multiple collaborators, includ-ing patients, caregivers, and health practitioners, sharing experiences of care at multiple stagesduring the design and implementation process to co-design products and services [35–37].EBCD has been used in a wide range of clinical areas and is considered best practice forleading improvements in health services [37]. Figure 1 describes the EBCD process of theICaRe project and the phases involved in this current study.Healthcare 2025, 13, x FOR PEER REVIEW 3 of 18 interventions provided to this population [18,31]. Therefore, the overall goal of this study was to examine the rehabilitation-related experiences of individuals with a history of sep-sis and cancer and to explore the educational needs of sepsis survivors as well as of their caregivers and the healthcare team. To achieve this goal, we had two research objectives: (1) examine the rehabilitation-related experiences and barriers to rehabilitation for indi-viduals with a history of sepsis and cancer, th ir caregivers, nd the healthcare team; (2) explore patient, caregiver, and health professional needs for educational r sources related to rehabilitation to improve the exp riences of those with sepsis. 2. Materials and Methods 2.1. Study Design We used a qualitative study design to achieve the research objectives. We performed a qualitative descriptive study [32,33] using interviews and focus groups. Qualitative de-scriptive studies are used when the goal is to provide a detailed description of a phenom-enon or experience, and they prioritize the detailed description of an experience, rather than seeking to interpret it in depth [32,33]. They are particularly useful when little is known on a topic and provide insight for an initial understanding [32,33]. The Hamilton Integrated Research Ethics Board approved this study (ID: 15072), and we ensured written informed consent from all participants. We report the findings of this study in accordance with the COnsolidated criteria for REporting Qualitative research (COREQ) checklist for interviews and focus groups (see Supplementary File S1) [34]. We undertook this study as part of the larger “ICaRe” project, which is an experience-based co-design (EBCD) project aiming to explore the Intersection of Cancer, sepsis, and frailty, and improve informational/educational tools describing the potential benefit of Rehabilitation services for these populations. EBCD is an approach involving multiple collaborators, including patients, caregivers, and health practitioners, sharing experiences of care at multiple stages during the design and implementation process to co-design products and services [35–37]. EBCD has been used in a wide range of clinical areas and is considered best practice for leading improvements in health services [37]. Figure 1 de-scribes the EBCD process of the ICaRe project and the phases involved in this current study. Figure 1. Experience-based co-design process of the ICaRe project. 2.2. Participants For the interview portion of this project, the study population included Canadians with a previous diagnosis of sepsis and cancer, their caregivers, or health professionals Stage 1: Observe Clinical Areas•Site observationsStage 2: Interview Stakeholders•Gather health professional and patient/caregiver experiences• Interview, transcribe, analyze findings using content analysisStage 3: Edit Interviews into Summary•Combine results from Stage 2 into a summaryStage 4-6: Hold and Analyze Stakeholder Events•Hold focus groups for health professionals and patient/caregiver partners: sharing findings from stage 2 and 3 and discuss needs, content, and format of educational resources•Transcribe and analyze findings using content analysisStage 7: Run Co-Design Process•Create resources using co-design based on steps 1-6• Involve diverse participants, gaining feedback throughout processStage 8: Hold Celebration Event•Share project results and educational resources•Discuss knowledge translation plansRed highlighted boxes (Stage 2-6) include current study proceduresFigure 1. Experience-based co-design process of the ICaRe project.2.2. ParticipantsFor the interview portion of this project, the study population included Canadians witha previous diagnosis of sepsis and cancer, their caregivers, or health professionals workingwith these populations. We included individuals with the following characteristics: (1) olderthan 18 years of age; (2) living in Canada; (3) able to understand English; (4) currentlyor previously diagnosed with sepsis as an adult and treated in hospital and previouslydiagnosed with cancer in adulthood (any type, stage, treatment status, or time sincetreatment for sepsis and cancer) or caregivers of someone with a current or past diagnosisHealthcare 2025, 13, 822 4 of 17of sepsis and cancer (any type, stage, treatment status, or time since treatment for sepsisand cancer) or healthcare professionals working with individuals with sepsis and cancer aspart of their routine practice. For the interview portion of this study, sepsis did not have tooccur during active cancer treatment, and the order of diagnosis of these conditions didnot matter. For the focus groups, the study population included Canadians with a previousdiagnosis of sepsis, their caregivers, or health professionals working with this population.We included individuals with the following characteristics: (1) older than 18 years of age,(2) living in Canada, (3) able to understand English, (4) currently or previously diagnosedwith sepsis as an adult and treated in hospital or caregivers of someone with a current orpast diagnosis of sepsis or healthcare professionals working with individuals with sepsisand cancer as part of their routine practice.2.3. RecruitmentWe used a mix of purposeful and snowball sampling to recruit participants for this project.Purposeful sampling included targeting community organizations supporting individualswith sepsis (i.e., Sepsis Canada and the Sepsis Alliance). These organizations received a studyadvertisement and email template to send out to their members, highlighting the inclusioncriteria. Interested individuals were asked to email the study team to determine their eligibilityand schedule an interview and/or a focus group. Further, we asked these same communityorganizations to post a recruitment advertisement for the interviews on their social mediaplatforms. Finally, we purposefully sent an email to hospital staff who were known by theresearch team to work with patients with sepsis and cancer in Canada to see if they werewilling to participate in this study. Once enrolled, we used snowball sampling by inviting theparticipants to suggest others to take part in the study.2.4. Data GenerationWe used two methods for collecting data: (1) individual virtual interviews; (2) virtualfocus groups. Supplementary File S2 reports the interview and focus group guide. Theuse of multiple sources of data ensured data triangulation. We conducted the interviewsfirst, from May to October 2023 to determine the rehabilitation-related experiences ofindividuals with a history of sepsis and cancer, their caregivers, and the healthcare team.These were one-on-one semi-structured interviews that lasted 30–60 min, where we askedthe participants to discuss their experiences and needs related to living with sepsis andcancer, rehabilitation, or working with individuals with sepsis and cancer. The interviewswere led by one of two study team members, including a critical care physiotherapist(A.N.L.N.), who was completing a post-doctoral fellowship at the time of the interviews,and a research assistant with previous experience in cancer rehabilitation research (J.P.),who was an MSc (physiotherapy) student at the time of the interviews.Following the interviews, we conducted two separate focus groups where we shared anoverview of the interview findings and explored the need for educational resources related torehabilitation to improve the experiences of those with sepsis and cancer. Each interview wasapproximately 90 min long and occurred via Zoom in November and December 2023. Duringthe focus group, we presented and discussed the interview findings and invited suggestionson the content and format of educational resources about these conditions and rehabilitation.The focus groups were led by a study team member (C.F.) who was a physiotherapist withclinical experience in the ICU and a PhD student. A research assistant (J.P.) took summarynotes during the focus groups, provided verbal and written summaries of the discussion tothe participants in the chat function on Zoom, and highlighted the overall atmosphere andfeel of the focus groups for the study team. The use of multiple researchers to collect andanalyze data ensured investigator triangulation within this study.Healthcare 2025, 13, 822 5 of 172.5. Sample SizeWe aimed to recruit 10–20 interview participants and 12–16 participants for the focusgroups [35]. In order to achieve adequate recruitment to answer our research questions, weensured saturation of data from the entire sample as a whole, confirming no new categorieswere emerging from the data, prior to stopping recruitment [38]. No criteria limited theinterview participants from taking part in the focus groups.2.6. Data AnalysisWe recorded interviews and focus group discussions and transcribed the recordingsverbatim, initially by using the Zoom transcription function. Two reviewers (J.S-T andJ.P.) analyzed the interview and focus group transcripts using qualitative content analysisand inductive coding [39]. We used independent line-by-line analysis to generate initialcodes and consensus to finalize and develop the definitions for codes. The codes werethen grouped and consolidated into categories. Independently, the investigators reviewedeach other’s coding of the transcripts to assure credibility. We extracted quotes from thetranscripts that corresponded to the established codes and categories. To organize andmanage the qualitative data, we used NVivo (Version 14).3. Results3.1. Participant DescriptionWe included 17 individuals for the one-on-one virtual interviews. One participantwithdrew from the study following the interview due to concerns about how their infor-mation would be received by their treating healthcare team, and another was removedfollowing their interview due to our team’s concerns regarding their eligibility (i.e., duringthe interview, they were not able to answer simple questions related to their sepsis andcancer diagnosis, and conflicting information was given in their responses regarding this).Therefore, we included 15 participants in the analysis (three patients with both sepsis andcancer, six caregivers of patients with sepsis and cancer, six healthcare professionals work-ing with individuals with sepsis and cancer). Most participants (n = 12; 80%) were female,and the mean participant age was 43 years. Of the patient participants, one was previouslydiagnosed with Hodgkin’s lymphoma, one with acute myeloid leukemia, and one withbladder cancer, and all were treated for sepsis as inpatients. The mean length of timesince sepsis diagnosis was 6.4 years. The mean length of time since cancer diagnosis was14 years. For the included caregiver participants, two cared for individuals with prostatecancer, and one each for individuals with non-Hodgkin’s lymphoma, chronic lymphocyticleukemia, lung cancer, and breast cancer. The mean length of time since sepsis diagnosisfor the individual they were caring for was 2.5 years. The mean length of time since cancerdiagnosis for the individual they were caring for was 5.5 years. The health professionalsincluded two nurses, one medical oncology fellow, one physiotherapist, one occupationaltherapist, and one medical doctor. All health professionals worked in inpatient settingsand were currently practicing.Fifteen participants took part in the focus groups (six patients—one with sepsis andcancer, five with sepsis only, all treated for sepsis as inpatients—three caregivers, andsix healthcare professionals who worked with inpatient populations); the majority werefemale (n = 14, 93%). One of the patient participants disclosed a previous cancer diagnosis(Hodgkin’s lymphoma, diagnosed 22 years ago). The mean length of time since sepsisdiagnosis for the focus group patient participants was 6.3 years. Two caregivers caredfor an individual with sepsis and cancer (prostate cancer and non-Hodgkin’s lymphoma).The mean length of time since sepsis diagnosis for the individual they were caring forwas 2.3 years. The mean length of time since cancer diagnosis for the individual theyHealthcare 2025, 13, 822 6 of 17were caring for was 3.5 years. The health professionals included two physiotherapists,two registered dietitians, one occupational therapist, and one nurse practitioner. Table 1provides the characteristics of the included individuals by participant type.Table 1. Characteristics by participant type (total N = 30).CharacteristicPatient (n = 9; 4 Diagnosedwith Sepsis and Cancer,5 with Sepsis Only)n (%)Caregiver (n = 9)n (%)Healthcare Professional(n = 12)n (%)SexMale 2 (22%) 0 2 (17%)Female 7 (78%) 9 (100%) 10 (83%)Age (Mean, SD) yrs 45.13, 10.27 44.75, 14.94 41.33, 7.63Cancer Type *Hodgkin’s Lymphoma 2 (22%) -Non-Hodgkin’sLymphoma - 2 (22%)Acute Myeloid Leukemia 1 (11%) -Chronic LymphocyticLeukemia - 1 (11%)Bladder Cancer 1 (11%) -Breast Cancer - 1 (11%)Prostate Cancer - 3 (33%)Lung Cancer - 1 (11%)Time since cancerdiagnosis * (mean, yrs) 165 (relates to individual theywere caring for)Time since sepsis diagnosis* (mean, yrs) 72 (relates to individual theywere caring for)* Note: questions answered for self or in relation to care recipient.3.2. Experiences with and Barriers to Rehabilitation (Research Objective 1)We identified three main themes related to rehabilitation for individuals with sepsisand cancer: (1) the rehabilitation experience did not meet the patient’s care expectations;(2) barriers to rehabilitation exist on multiple levels; (3) there are important gaps in educa-tion on how to improve physical and psychosocial outcomes.3.2.1. The Rehabilitation Experience Did Not Meet the Patient’s Care ExpectationsThe participants highlighted that the rehabilitation they received during their care forsepsis and cancer ‘missed the mark’. Both patient and caregiver participants felt that onceindividuals were discharged from the hospital, they were on their own to find and pay forrehabilitation services.“So, it was basically. . .one long period of time [in hospital] of physio, OT [occupa-tional therapy], SLP [speech language pathology], dietitian, social work, and thenonce I was home, obviously those things. . .were very intermittent in the servicesI was receiving”.(Patient, female)Healthcare 2025, 13, 822 7 of 17“We had to pay for an occupational therapist to come see my mom when shewas discharged to. . .talk about whatever it is occupational therapists do! Andthen. . .she had physio, I suppose, come to the house every week or so to give herexercises to do”.(Caregiver, female)Many health professionals mentioned that rehabilitation was valued by the healthcareteam but was provided inconsistently across the phases of care.“If I have a patient in front of me who I deem needs admission because of theircurrent medical or frailty status. . .then yes, the inpatient admitting service wouldmake arrangements for the appropriate allied health services [e.g., physiotherapy(PT), OT] to see those patients. . .my main concern is the patients who go homeand what they’re able to access. It’s a comfort sometimes when I can admit apatient and know that they’ll be seen by my inpatient [team]”.(Health professional, female)“[The] ICU doesn’t utilize OT because it’s so early in the course of treatment thatOT isn’t necessarily the most appropriate treatment. . .I see people in their sickest,most acute phases, so I don’t get to see much that happens from the rehab pointof view once they leave the intensive care setting”.(Health professional, female)It was highlighted by all participant groups that a multi-disciplinary approach to care,including rehabilitation professionals, is needed to improve the outcomes of those withcancer and sepsis.“We always order PT and OT because they need to get going. It’s part of ouradmission package, which is great...I can’t think of an example where I didn’t usePT, OT, actually”.(Health professional, male)“Sepsis is head-to-toe systemic, so I think that for the physiotherapists and oc-cupational therapists to really have an opportunity to study and research waysthat would improve the quality of lives for patients. . .and. . .nutrition. . .the rightcombination of strengthening and conditioning [is needed and important]”.(Caregiver, female)3.2.2. Barriers to Rehabilitation Exist on Multiple LevelsThe participants described a wide variety of barriers to rehabilitation during and aftercare for cancer and sepsis. They discussed external and internal influences that affectedthe availability of rehabilitation services. External influences included COVID-19 and theavailability and costs of community rehabilitation services. These ideas were brought forthin statements such as:“My mom had a lot of barriers because she had cancer and sepsis during COVID,so I think there was a lot less opportunities to go see someone. It had to be in thehospital or at the house. My mom wasn’t allowed to leave the house because ofthe potential of getting COVID during cancer. . .so my mom just didn’t leave thehouse. So, it was tough for my mom to get that if it wasn’t offered at the hospitalspecifically”.(Caregiver, female)Healthcare 2025, 13, 822 8 of 17“We only had an OT maybe once in the hospital, and then we paid for someoneat home to come visit her, but it wasn’t much. . .we didn’t see them as often. . .itwould be more helpful if they could come every day—I mean, and I get it fundingand money [make it difficult]”.(Caregiver, female)“When you transition from peds [pediatrics] to adult, it’s like they throw you tothe wolves, and if you don’t know how to advocate for yourself, you’re kind of[in trouble] because advocating for appointments, advocating for services thatyou might need, advocating for a diagnosis or a test or whatever. . .if you don’tknow how to advocate for yourself when you’re an adult, you’re kind of left tofend for yourself”.(Health professional, female)Internal influences included health professional time in hospital, healthcare profes-sional burnout, and workplace culture. These influences were evident in statements such as:“They were too busy, number one, to spend much time [with us]. They hadsuch a huge roster, and they were not all equally educated in the treatment andmanagement of potential sepsis”.(Caregiver, female)“COVID made it worse because of the burnout, because of staffing. . .the acuity ofpatients we had with COVID. . .was very labor-intensive. The additional mental,emotional, and physical demands that COVID brought added to fatigue andburnout levels, which affected staffing”.(Health professional, female)“There are challenges in some units, our units included, where there may be. . .aculture that mobility is more of a—it’s not as necessary as we believe it is, so weoften, as physios, have to really advocate for our patients that mobility is reallyan important piece to prevent them from declining and to allow them to have thebest quality of life once they’ve recovered from their critical illness”.(Health professional, male)The impact of social support affecting the ability to participate in rehabilitation wasanother internal barrier highlighted in statements such as:“[The nurses]. . . they have other patients, and so my mom probably wasn’t gettingthe encouragement [to do her exercises], or she just wanted to sleep. When shewas at home, my dad could be like, ‘okay, we’re going to do X’ or me, ‘Okay,mom, let’s do some exercises”. She had that encouragement and someone to alsospot her if she was to get weak or fall”.(Caregiver, female)“The biggest challenge. . .is that they don’t necessarily get the intensive supportthat we provide in the ICU setting once they hit the wards, so I think there’s a bitof a disconnect there and some disappointment that they’re not getting the samelevel of physiotherapy or rehab once they leave our unit”.(Health professional, female)3.2.3. There Are Important Gaps in Education on How to Improve Physical andPsychosocial OutcomesThe participants described gaps in the education they received that were beyond thefield of rehabilitation, which affected them physically and psychologically during andHealthcare 2025, 13, 822 9 of 17after treatment for sepsis and cancer. One common theme was that sepsis education wasdelayed, which led to fear and anxiety among patients and caregivers. It was also broughtforth repeatedly that patients and caregivers had to independently search for informationon sepsis and/or the link to cancer. This was highlighted in statements such as “the actualdiagnosis of sepsis, I learned all of it on my own” (caregiver, female) and in others such as:“I had just looked up sepsis, and I came across the foundation. And then thathelped me a little bit too. . .but. . .you start searching everywhere and everythingto try to understand every single aspect”.(Patient, female)“When my mom was going through sepsis or septic shock, they were trying sohard to save her life, we were only given access to the nurses. . . they can’t tell mewhy this happened or the reason why my mom got sepsis, or the connection thatit had to cancer. . .the information that I’ve learned from sepsis and septic shockis from. . .Sepsis Canada and learning about everything after. To be honest, whenmy mom was diagnosed with sepsis, I had no idea what that is or what it meant.My dad had no idea. My brothers had no idea. So, I think in general, sepsisis just not very well known or talked about even though it’s insanely seriousand common”.(Caregiver, female)Health professionals said that they had a lack of entry-level education on these con-ditions and the role of rehabilitation in improving outcomes, which affected the care theyprovided: “In my original entry-level physio training we covered. . . I think we might have had onelecture on cancer” (health professional, male). Further:“During my formal education. . .as a medical student, I would say minimal tonone [information on rehab for cancer and/or sepsis]. Because I did do electives inphysiatry and geriatrics, I had a bit more exposure, but those were not mandatoryrotations by any means. So, you know, some of my colleagues who went throughwith me would have had even less formal training”.(Health professional, female)3.3. Patient and Caregiver Education Needs (Research Objective 2)We identified two main themes related to focus group participants’ needs for educa-tional resources to improve the experiences of those with sepsis: (1) educational contentprovided must be specific and meaningful; (2) multi-modal resources are needed to suitdiverse stakeholder needs.3.3.1. Educational Content Provided Must Be Specific and MeaningfulThe focus group participants identified many ideas describing the content that shouldbe included in future educational resources (see Table 2 for a list of suggested content).These participants highlighted that content must be short and easy to digest, includeexamples, and normalize the experience of having to regain function post sepsis, as follows:“Simple stuff that’s going to stick in your head that doesn’t take a ton of time toprocess/to think about. . .that you can stick up on your wall, that you can haveposted in a cancer center. Something like that could be helpful”.(Patient, female)“I would personally love to see examples. You know, I was very frustrated. Iwasn’t given rehab in the hospital and when I came home. . .I had worked out alot before and all of a sudden. . .I would faint every time I walked. . .really specificHealthcare 2025, 13, 822 10 of 17examples of what can be done [are needed]. You know, from bed. What can bedone from seated?”.(Patient, female)“I think it’s an important thing to let people know what they’re experiencing, thefrustrations [with function] are okay. . .just keep at it and don’t rush and you cando it”.(Patient, female)“[We need to] educate [survivors or sepsis and/or cancer patients] on the possibleoutcomes so that . . .they know what to look for and they know what’s coming”.(Health professional, female)The focus group participants also described the need for different educational re-sources for different partner types (i.e., different information for healthcare professionals,patients, and caregivers).“The language in healthcare and the language in the community are two differentlanguages”.(Patient, female)“Medical terminology for sure for those medically educated. . .And then of coursebreaking down in layman’s terms, very simple [for patients]. . . because whenyou’re sick, you can’t really decipher everything. . .so make it really simple forthose that are going through it”.(Patient, female)Table 2. Suggested content for future educational material.Education Content for Patients and Caregivers Education Content for Health Professionals Mode of EducationAvailable support groups for individualspost sepsisAwareness of personal biases and how theyinfluence care E-modules for continuous reviewCommon signs and symptoms during andafter sepsisCommunicating with patients with sepsis andcancer Social media postsHow to recognize sepsis Discharge considerationsVisuals: handout/poster/brochure;information card; wall stickers; postcard;tip sheet for family membersHow to talk to your family about sepsis Evaluation tools/outcome measures to usewith this populationHow to talk to health professionals about cancerand sepsis Information on post-sepsis syndromeLink between sepsis and frailty Sleep education Short videos: commercialLink between sepsis and cancer Sepsis general information (What is it? How torecognize it?)Website housing all material to make iteasy to accessMental wellbeing during and after sepsis Pain management strategiesNutritional advice Screening for rehabilitation and diet needsPreventing sepsis in those with cancer (i.e., diet,exercise, other lifestyle modifications)Prognosis (physical and health-related) post sepsisRehabilitation: benefits during and after cancerand sepsisRehabilitation: what exercises to do and how tomonitor intensity of exerciseRehabilitation: managing expectationsWhere to ask questions/get more information postcancer and sepsisHealthcare 2025, 13, 822 11 of 173.3.2. Multi-Modal Resources Are Needed to Suit Diverse Partner NeedsThe focus group participants highlighted the need for a wide variety of modes ofeducation to suit individual patient, caregiver, and health professional needs (Table 2):“I think the reality is a lot of people learn in different ways and a lot of people[have unique needs]. . . at certain phases you need something simple like thatbeautiful brochure that’s simple and easy to read and then you want more contentso the education modules might be helpful. . .you know where you’ve been andwhere you’re going”.(Patient, female)“Educational material should be available online but also I think that it’s some-thing that can be handed out in the hospital for family to be able to read up on. Ireally wished that I was more informed about the reality of sepsis. It wasn’t untilI was home and googled sepsis that I truly understood the severity of it”.(Patient, male)“Written is helpful because it allows people to refer back to it, but truly, becauseeverybody is so unique, I think there has to be someone that’s able to sit downand explain things to people. . .tailor it to their unique situation a little bit”.(Health professional, female)4. DiscussionThis qualitative study provides preliminary evidence addressing the specific needsof individuals with cancer and sepsis, their caregivers, and the healthcare team relatedto rehabilitation during and after treatment. The results suggest that the rehabilitationservices received by our participants did not meet their needs, and that this population, theircaregivers, and the healthcare professionals had barriers to rehabilitative care includingthe systemic nature of sepsis, the COVID-19 pandemic, access to rehabilitation services,lack of social support, and workplace culture. This study also explored the educationneeds of individuals with sepsis and their caregivers. The results demonstrate the needfor multi-modal education resources highlighting content in clear and concise ways toinform individuals with sepsis and cancer on the link between these conditions and therehabilitation strategies to improve outcomes.Consistent with previous studies in cancer rehabilitation [40–43], access to serviceswas as a major barrier to rehabilitation during and after treatment for sepsis and cancer.Specifically, after sepsis, the participants in this study described having to seek out andindependently pay for rehabilitation services. This is consistent with a 2023 study [28]that surveyed survivors of sepsis recently discharged from the ICU and their caregiverson unmet needs and found that access to timely rehabilitation during and after hospitaladmission was a primary unmet need of the respondents. However, in our study, additionalbarriers to rehabilitation were also identified, including external influences (i.e., COVID-19)and internal barriers, such as healthcare professional burnout and workplace culture.These are likely due to the timing of this study and the lingering effects of the pandemicon the healthcare system in Canada, including staff shortages, changes to public healthmeasures, and increased wait lists for procedures [44–46]. During the pandemic, manyhealthcare professionals were required to take on roles outside of their normal duties,and therefore, decreased access to quality care has been described by patients [47,48].While the pandemic may be over, research in Canada demonstrates that burnout amongpublic healthcare workers continues to be high (almost 79% of the healthcare workerssurveyed said they were burnt out; 88% suffered from disengagement) [49]. Overcomingthese continued obstacles for rehabilitation professionals requires focus to ensure accessHealthcare 2025, 13, 822 12 of 17to equitable care [49]. It was also evident from this study that many patient and caregiverparticipants were not aware of the need for rehabilitation during or after a sepsis diagnosis.This lack of knowledge on the benefit of rehabilitation to manage the impacts of a medicaldiagnosis is common in many other conditions [41,50], and therefore the need to createmechanisms to increase knowledge on how to improve outcomes is an area for futureresearch. Additionally, information not only on the benefit of rehabilitation services butalso on ‘how to’ implement rehabilitation into daily life, including exercise intensity, timing,parameters, and progressions, was suggested as necessary in this study and is an area ofneeded consideration by clinicians.While the aim of our study was to explore the educational needs related to rehabili-tation of those with a previous diagnosis of sepsis, a lack of general knowledge on whatsepsis is, why it happens, the link between sepsis and cancer, and post-sepsis outcomes,such as frailty, came forth consistently. This lack of or delayed knowledge was described asleading to fear and increased anxiety in those with these conditions and their caregivers.Early education, using any media, can reduce patient anxiety [51,52]. Further, many of ourparticipants described needing to search for information independently and learn aboutcomplications and the sequelae on their own and questioned whether the information thatthey found was accurate. Our study supports the need for more education on sepsis andits link to cancer to improve patient experience and outcomes.From the healthcare professional standpoint, many shared that they received little infor-mation regarding sepsis, post-sepsis syndrome, or rehabilitation during their training. Whileit is unclear why this gap exists, it is clear that a lack of knowledge on sepsis and the benefitof rehabilitation post sepsis diagnosis can prevent or cause delay in appropriate treatmentand lead to the developed of significant side effects limiting function [25,26,28]. As with pastresearch [50,53], this highlights the need to also create educational resources for healthcareprofessionals regarding the intersection of these conditions and the potential for rehabilitationto improve outcomes. Our study identified a knowledge gap for healthcare professional onthe available evidence-based community rehabilitation resources for patients, consistent withprevious literature for individuals with cancer [50,54,55]. Therefore, in addition to assessmentand basic management techniques, an inventory of available resources and easy referralpathways to help patients access rehabilitation care is needed.This project is part of a larger EBCD process [35,37], looking to create meaningful high-quality educational resources for individuals with a diagnosis of sepsis and cancer. Animportant foundational component of this phase of research engages diverse partner perspec-tives and considerations for creating resources in follow-up phases. Consistent with otherliterature examining patient education resources in healthcare [51,52], these recommendationsinclude multi-modal rehabilitation resources (i.e., paper and electronic) of different lengths forindividuals at different points of care. Further, general reminders and prompts on what sepsisis and how to identify it were recommended by our focus group participants. Healthcareprompts are tools that help to deliver messages to motivate individuals to change behav-iors [56,57]. They have previously been used successfully in the cancer rehabilitation literatureto increase movement and physical activity discussion [58,59]; however, there are no studiesexamining the use of prompts in relation to sepsis, highlighting an area of future research.Overall, the participants highlighted that the content needs to be ‘readable’, clear, and easyto digest.Strengths and LimitationsThe strengths of this study include the novelty of the research question, the inclusionof diverse participants, and the use of data triangulation (through both interview and focusgroup methodology) and investigator triangulation (different researchers collected andHealthcare 2025, 13, 822 13 of 17analyzed the data), which together provided meaningful results to build on in future work.Further, the iterative content analysis using multiple reviewers strengthens the validityof the methods used in this qualitative study. However, the findings should be viewedwith an understanding of their limitations. All participants resided in Canada, and most ofthe patient participants were diagnosed and treated in Ontario. Most individuals with asepsis diagnosis in this study described their experience with rehabilitation as inpatientsand reported a lack of outpatient rehabilitation services. Therefore, further research needsto explore outpatient rehabilitation strategies post hospital discharge. Further, this studyis limited by its small sample size and the fact that most of our participants identified asfemale, which may be due to our recruitment procedure and methods used (interviewsand focus groups), which have been shown in the literature to be more acceptable byfemale participants and may have led to sampling and sex/gender biases. Additionally,our recruitment methods may not have reached potentially eligible people who do notaccess social media or are not on the email lists of our partners. We also collected datausing virtual means only, which may have limited the participation of those without accessto technology and the study generalizability. Additionally, the recruitment of ineligibleparticipants using social media has become a problem in data generation [60,61]. Ourstudy team experienced many ineligible participation requests in this study and had todiligently screen to ensure eligibility. Additionally, while we ensured that saturation of dataoccurred within our entire sample during analysis, we were not able to ensure saturation byindividual participant type or characteristics (i.e., cancer type, time since the diagnosis ofsepsis or cancer, health professional type), as our participants included health professionaltypes and individuals with different stages of cancer that were only represented by oneparticipant. Further, we did not collect social or cultural demographic data and thereforecould not analyze our data based on these criteria. Therefore, this study did not describespecific problems related to those with specific types of cancer or sub-types of sepsis, butonly addressed general patient issues, which future research can build upon in largerpopulations. Hence, these results must be interpreted with this consideration. Finally,while this study focused on sepsis and cancer, it became clear that rehabilitation post sepsisin general was of utmost interest to many of the participants and is an area that is relativelyunexplored. Future research should focus on developing rehabilitation strategies for thisspecific population.5. ConclusionsWe identified gaps in the care of the participants in our study. Rehabilitation wasidentified as an area of future need by all participants. The interview participants in thisstudy were unaware of the benefit of rehabilitation during and after sepsis and cancer anddid not know what to do to regain function and improve overall outcomes. We identifiedimportant barriers to rehabilitation for this population related to lack of knowledge, lack ofavailable resources, healthcare settings, the pandemic, and workplace culture. This studyhighlights the need to create educational resources for diverse participants focusing onrehabilitation for those with sepsis and cancer to improve outcomes and highlighting theimportance of the link between these two conditions. These resources should be specific andprovide information on how to access and engage in rehabilitation at various points acrossthe care trajectory. Future research should build on this by engaging a larger representationof patients with sepsis and cancer.Supplementary Materials: The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/healthcare13070822/s1, Supplementary File S1: COREQ checklist;Supplementary File S2: Interview and focus group guide.Healthcare 2025, 13, 822 14 of 17Author Contributions: Conceptualization: J.S.-T. and M.E.K.; methodology: J.S.-T., A.N.L.N., C.F.,S.D.M., M.B., B.R., L.C.L. and H.M.; formal analysis and investigation: J.S.-T., A.N.L.N., C.F. andJ.P.; writing—original draft preparation: J.S.-T.; writing—reviewing and editing: C.F., A.N.L.N., J.P.,S.D.M., M.B., B.R., L.C.L. and M.E.K.; funding acquisition: J.S.-T.; resources: J.S.-T. and M.E.K.; super-vision: J.S.-T. and M.E.K. All authors have read and agreed to the published version of the manuscript.Funding: This research was partially supported by a research grant from the Sepsis Canada Network,which is supported by the Canadian Institute of Health Research. This research was also partiallyfunded by the Canadian Frailty Network, which is supported by the Government of Canada throughthe Networks of Centres of Excellence (NCE) program. Both funders contributed to the SpringboardGrants Program: Early Career Researcher Award (ID: ECR2022-013), held by the primary investigator(JST). MB and MEK held Canada Research Chairs during this study. The funders had no role in thedesign, analysis, or interpretation of the data.Institutional Review Board Statement: The Hamilton Integrated Research Ethics Board approvedthis study (ID: 15072; 24 October 2022).Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.Data Availability Statement: The data supporting the findings of this review are available from thecorresponding author, J.S.-T., upon reasonable request.Conflicts of Interest: The authors declare no conflicts of interest. The funders had no role in the designof the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; orin the decision to publish the results.AbbreviationsThe following abbreviations are used in this manuscript:COREQ COnsolidated criteria for REporting Qualitative researchEBCD Experience-based co-designOT Occupational therapySLP Speech language pathologyPT PhysiotherapyReferences1. Sepsis Alliance. Sepsis and Cancer. Available online: https://www.sepsis.org/sepsisand/cancer/ (accessed on 1 June 2024).2. Centre for Disease Control Prevention. Risk Factors for Sepsis. Available online: https://www.cdc.gov/sepsis/risk-factors/index.html. (accessed on 1 June 2024).3. Rudd, K.E.; Johnson, S.C.; Agesa, K.M.; Shackelford, K.A.; Tsoi, D.; Kievlan, D.R.; Colombara, D.V.; Ikuta, K.S.; Kissoon, N.; Finfer,S.; et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: Analysis for the Global Burden of Disease Study.Lancet 2020, 395, 200–211. [CrossRef] [PubMed]4. Andersen, S.K.; Herridge, M.S.; Fiest, K.M. Recovery from Sepsis: Management beyond Acute Care. In Seminars in Respiratory andCritical Care Medicine; Thieme Medical Publishers, Inc.: New York, NY, USA, 2024. [CrossRef]5. Canadian Cancer Society. Cancer Statistics at a Glance. Available online: https://cancer.ca/en/research/cancer-statistics/cancer-statistics-at-a-glance (accessed on 1 February 2024).6. van der Slikke, E.C.; Beumeler, L.F.E.; Holmqvist, M.; Linder, A.; Mankowski, R.T.; Bouma, H.R. Understanding Post-SepsisSyndrome: How Can Clinicians Help? Infect. Drug Resist. 2023, 16, 6493–6511. [CrossRef]7. Cuthbertson, B.H.; Elders, A.; Hall, S.; Taylor, J.; MacLennan, G.; Mackirdy, F.; Mackenzie, S.J.; The Scottish Critical Care TrialsGroup; The Scottish Intensive Care Society Audit Group. Mortality and quality of life in the five years after severe sepsis. Crit.Care 2013, 17, R70. [CrossRef]8. Prescott, H.C.; Angus, D.C. Enhancing Recovery From Sepsis: A Review. JAMA 2018, 319, 62–75. [CrossRef]9. Prescott, H.C.; Costa, D.K. Improving Long-Term Outcomes After Sepsis. Crit. Care Clin. 2018, 34, 175–188. [CrossRef]10. Mostel, Z.; Perl, A.; Marck, M.; Mehdi, S.F.; Lowell, B.; Bathija, S.; Santosh, R.; Pavlov, V.A.; Chavan, S.S.; Roth, J. Post-sepsissyndrome—An evolving entity that afflicts survivors of sepsis. Mol. Med. 2019, 26, 6. [CrossRef]11. Sepsis Alliance. Post-Sepsis Syndrome. Available online: https://www.sepsis.org/sepsis-basics/post-sepsis-syndrome/(accessed on 30 April 2024).Healthcare 2025, 13, 822 15 of 1712. Skei, N.V.; Moe, K.; Nilsen, T.I.L.; Aasdahl, L.; Prescott, H.C.; Damas, J.K.; Gustad, L.T. Return to work after hospitalization forsepsis: A nationwide, registry-based cohort study. Crit. Care 2023, 27, 443. [CrossRef]13. Fleischmann-Struzek, C.; Ditscheid, B.; Rose, N.; Spoden, M.; Wedekind, L.; Schlattmann, P.; Gunster, C.; Reinhart, K.; Hartog,C.S.; Freytag, A. Return to work after sepsis-a German population-based health claims study. Front. Med. 2023, 10, 1187809.[CrossRef]14. Hurria, A.; Jones, L.; Muss, H.B. Cancer Treatment as an Accelerated Aging Process: Assessment, Biomarkers, and Interventions.Am. Soc. Clin. Oncol. Educ. Book 2016, 35, e516–e522. [CrossRef]15. Henderson, T.O.; Ness, K.K.; Cohen, H.J. Accelerated aging among cancer survivors: From pediatrics to geriatrics. Am. Soc. Clin.Oncol. Educ. Book 2014, 34, e423–e430. [CrossRef]16. Ballinger, R.S.; Fallowfield, L.J. Quality of life and patient-reported outcomes in the older breast cancer patient. Clin. Oncol. 2009,21, 140–155. [CrossRef]17. Ewertz, M.; Jensen, A.B. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol. 2011, 50, 187–193.[CrossRef] [PubMed]18. Gudiol, C.; Albasanz-Puig, A.; Cuervo, G.; Carratala, J. Understanding and Managing Sepsis in Patients with Cancer in the Era ofAntimicrobial Resistance. Front. Med. 2021, 8, 636547. [CrossRef]19. World Health Organization. Rehabilitation. Available online: https://www.who.int/health-topics/rehabilitation#tab=tab_1(accessed on 30 April 2024).20. Campbell, K.L.; Winters-Stone, K.M.; Wiskemann, J.; May, A.M.; Schwartz, A.L.; Courneya, K.S.; Zucker, D.S.; Matthews,C.E.; Ligibel, J.A.; Gerber, L.H.; et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from InternationalMultidisciplinary Roundtable. Med. Sci. Sports Exerc. 2019, 51, 2375–2390. [CrossRef]21. Schmid, D.; Leitzmann, M.F. Association between physical activity and mortality among breast cancer and colorectal cancersurvivors: A systematic review and meta-analysis. Ann. Oncol. 2014, 25, 1293–1311. [CrossRef]22. Sabiston, C.M.; Brunet, J. Reviewing the Benefits of Physical Activity During Cancer Survivorship. Am. J. Lifestyle Med. 2012, 6,167–177.23. Gerritsen, J.K.; Vincent, A.J. Exercise improves quality of life in patients with cancer: A systematic review and meta-analysis ofrandomised controlled trials. Br. J. Sports Med. 2016, 50, 796–803. [CrossRef]24. Furmaniak, A.C.; Menig, M.; Markes, M.H. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane DatabaseSyst. Rev. 2016, 9, CD005001. [CrossRef]25. Taito, S.; Taito, M.; Banno, M.; Tsujimoto, H.; Kataoka, Y.; Tsujimoto, Y. Rehabilitation for patients with sepsis: A systematicreview and meta-analysis. PLoS ONE 2018, 13, e0201292. [CrossRef]26. Sakai, Y.; Yamamoto, S.; Karasawa, T.; Sato, M.; Nitta, K.; Okada, M.; Takeshige, K.; Ikegami, S.; Imamura, H.; Horiuchi, H. Effectsof early rehabilitation in sepsis patients by a specialized physical therapist in an emergency center on the return to activities ofdaily living independence: A retrospective cohort study. PLoS ONE 2022, 17, e0266348. [CrossRef]27. Kayambu, G.; Boots, R.; Paratz, J. Early physical rehabilitation in intensive care patients with sepsis syndromes: A pilotrandomised controlled trial. Intensive Care Med. 2015, 41, 865–874. [CrossRef] [PubMed]28. Born, S.; Matthaus-Kramer, C.; Bichmann, A.; Boltz, H.S.; Esch, M.; Heydt, L.; Sell, S.; Streich, K.; Scherag, A.; Reinhart, K.; et al.Sepsis survivors and caregivers perspectives on post-acute rehabilitation and aftercare in the first year after sepsis in Germany.Front. Med. 2023, 10, 1137027. [CrossRef]29. Huang, C.Y.; Daniels, R.; Lembo, A.; Hartog, C.; O’Brien, J.; Heymann, T.; Reinhart, K.; Nguyen, H.B.; Sepsis SurvivorsEngagement, P. Life after sepsis: An international survey of survivors to understand the post-sepsis syndrome. Int. J. Qual. HealthCare 2019, 31, 191–198. [CrossRef]30. Gallop, K.H.; Kerr, C.E.; Nixon, A.; Verdian, L.; Barney, J.B.; Beale, R.J. A qualitative investigation of patients’ and caregivers’experiences of severe sepsis. Crit. Care Med. 2015, 43, 296–307. [CrossRef]31. Mirouse, A.; Vigneron, C.; Llitjos, J.F.; Chiche, J.D.; Mira, J.P.; Mokart, D.; Azoulay, E.; Pene, F. Sepsis and Cancer: An Interplay ofFriends and Foes. Am. J. Respir. Crit. Care Med. 2020, 202, 1625–1635. [CrossRef]32. Sandelowski, M. What’s in a name? Qualitative description revisited. Res. Nurs. Health 2010, 33, 77–84. [CrossRef]33. Sandelowski, M. Whatever happened to qualitative description? Res. Nurs. Health 2000, 23, 334–340. [CrossRef]34. Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist forinterviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [CrossRef]35. Point of Care Foundation. EBCD: Experience-Based Co-Design Toolkit. Available online: https://www.pointofcarefoundation.org.uk/resource/experience-based-co-design-ebcd-toolkit/ (accessed on 30 April 2024).36. Green, T.; Bonner, A.; Teleni, L.; Bradford, N.; Purtell, L.; Douglas, C.; Yates, P.; MacAndrew, M.; Dao, H.Y.; Chan, R.J. Use andreporting of experience-based codesign studies in the healthcare setting: A systematic review. BMJ Qual. Saf. 2020, 29, 64–76.[CrossRef]Healthcare 2025, 13, 822 16 of 1737. Fucile, B.; Bridge, E.; Duliban, C.; Law, M.P. Experience-based co-design: A method for patient and family engagement insystem-level quality improvement. Patient Exp. J. 2017, 4, 53–60.38. Saunders, B.; Sim, J.; Kingstone, T.; Baker, S.; Waterfield, J.; Bartlam, B.; Burroughs, H.; Jinks, C. Saturation in qualitative research:Exploring its conceptualization and operationalization. Qual. Quant. 2018, 52, 1893–1907. [CrossRef] [PubMed]39. Erlingsson, C.; Brysiewicz, P. A hands-on guide to doing content analysis. Afr. J. Emerg. Med. 2017, 7, 93–99. [CrossRef] [PubMed]40. Brunet, J.; Taran, S.; Burke, S.; Sabiston, C.M. A qualitative exploration of barriers and motivators to physical activity participationin women treated for breast cancer. Disabil. Rehabil. 2013, 35, 2038–2045. [CrossRef] [PubMed]41. Fernandez, S.; Franklin, J.; Amlani, N.; DeMilleVille, C.; Lawson, D.; Smith, J. Physical activity and cancer: A cross-sectionalstudy on the barriers and facilitators to exercise during cancer treatment. Can. Oncol. Nurs. J. 2015, 25, 37–48. [CrossRef]42. Frikkel, J.; Gotte, M.; Beckmann, M.; Kasper, S.; Hense, J.; Teufel, M.; Schuler, M.; Tewes, M. Fatigue, barriers to physical activityand predictors for motivation to exercise in advanced Cancer patients. BMC Palliat. Care 2020, 19, 43. [CrossRef]43. Sander, A.P.; Wilson, J.; Izzo, N.; Mountford, S.A.; Hayes, K.W. Factors that affect decisions about physical activity and exercise insurvivors of breast cancer: A qualitative study. Phys. Ther. 2012, 92, 525–536. [CrossRef]44. Canadian Institute for Health Information. Overview: COVID-19’s Impact of Health Care Systems. Available online:https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/the-big-picture (accessed on8 May 2024).45. Beogo, I.; Bationo, N.J.; Sia, D.; Collin, S.; Kinkumba Ramazani, B.; Letourneau, A.A.; Ramde, J.; Gagnon, M.P.; Tchouaket, E.N.COVID-19 pandemic or chaos time management: First-line worker shortage—A qualitative study in three Canadian Provinces.BMC Geriatr. 2022, 22, 727. [CrossRef]46. Galanis, P.; Vraka, I.; Fragkou, D.; Bilali, A.; Kaitelidou, D. Nurses’ burnout and associated risk factors during the COVID-19pandemic: A systematic review and meta-analysis. J. Adv. Nurs. 2021, 77, 3286–3302. [CrossRef]47. Elliott, M.N.; Beckett, M.K.; Cohea, C.W.; Lehrman, W.G.; Cleary, P.D.; Giordano, L.A.; Russ, C.; Goldstein, E.H.; Fleisher,L.A. Changes in Patient Experiences of Hospital Care During the COVID-19 Pandemic. JAMA Health Forum 2023, 4, e232766.[CrossRef]48. Tuczynska, M.; Staszewski, R.; Matthews-Kozanecka, M.; Zok, A.; Baum, E. Quality of the Healthcare Services During COVID-19Pandemic in Selected European Countries. Front. Public Health 2022, 10, 870314. [CrossRef]49. Singh, J.; Poon, D.E.; Alvarez, E.; Anderson, L.; Verschoor, C.P.; Sutton, A.; Zendo, Z.; Piggott, T.; Apatu, E.; Churipuy, D.; et al.Burnout among public health workers in Canada: A cross-sectional study. BMC Public Health 2024, 24, 48. [CrossRef]50. Smith-Turchyn, J.; Richardson, J.; Tozer, R.; McNeely, M.; Thabane, L. Physical Activity and Breast Cancer: A Qualitative Study onthe Barriers to and Facilitators of Exercise Promotion from the Perspective of Health Care Professionals. Physiother. Can. 2016, 68,383–390. [CrossRef] [PubMed]51. Stucky, C.; Vortman, R. Nurse-led strategies to decrease preoperative patient anxiety. Nursing 2022, 52, 10–11. [CrossRef][PubMed]52. Althobiti, E.; Almashi, A.; Albawinei, A.; Alnashri, F. Effect of Preoperative Education on Patient Anxiety Level: A ScopingReview. Evid. Based Nurs. 2020, 2, 40–49. [CrossRef]53. Adams, S.C.; Smith-Turchyn, J.; Santa Mina, D.; Neil-Sztramko, S.; Cormie, P.; Culos-Reed, S.N.; Campbell, K.L.; Pugh, G.;Langelier, D.; Schmitz, K.H.; et al. The Exercise Oncology Knowledge Mobilization Initiative: An International Modified DelphiStudy. Front. Oncol. 2021, 11, 713199. [CrossRef]54. Nadler, M.; Bainbridge, D.; Tomasone, J.; Cheifetz, O.; Juergens, R.A.; Sussman, J. Oncology care provider perspectives on exercisepromotion in people with cancer: An examination of knowledge, practices, barriers, and facilitators. Support. Care Cancer 2017, 25,2297–2304. [CrossRef]55. Fong, A.J.; Faulkner, G.; Jones, J.M.; Sabiston, C.M. A qualitative analysis of oncology clinicians’ perceptions and barriers forphysical activity counseling in breast cancer survivors. Support. Care Cancer 2018, 26, 3117–3126. [CrossRef]56. Centre for Disease Control and Prevention. Strategies for Prompts to Encougae Physical Activity. Available online:https://www.cdc.gov/physical-activity/php/strategies/encouraging-physical-activity.html#:~:text=Motivational%20signs%20or%20other%20prompts,health%20benefits%20of%20physical%20activity. (accessed on 28 March 2024).57. Arditi, C.; Rege-Walther, M.; Wyatt, J.C.; Durieux, P.; Burnand, B. Computer-generated reminders delivered on paper to healthcareprofessionals; effects on professional practice and health care outcomes. Cochrane Database Syst. Rev. 2012, 12, CD001175.[CrossRef]58. Neff, R.; Fry, J. Periodic Prompts and Reminders in Health Promotion and Health Behavior Interventions: Systematic Review. J.Med. Internet Res. 2009, 11, e16. [CrossRef]59. Smith-Turchyn, J.; Mukherjee, S.D.; Tomasone, J.R.; Fong, A.J.; Nayiga, B.K.; Ball, E.; Stouth, D.W.; Sabiston, C.M. EvaluatingWall-Mounted Prompts to Facilitate Physical Activity-Related Discussion between Individuals with Cancer and Oncology HealthCare Providers: A Pre-post Survey Study. Physiother. Can. 2024, 76, 34–45. [CrossRef]Healthcare 2025, 13, 822 17 of 1760. Pozzar, R.; Hammer, M.J.; Underhill-Blazey, M.; Wright, A.A.; Tulsky, J.A.; Hong, F.; Gundersen, D.A.; Berry, D.L. Threats ofBots and Other Bad Actors to Data Quality Following Research Participant Recruitment Through Social Media: Cross-SectionalQuestionnaire. J. Med. Internet Res. 2020, 22, e23021. [CrossRef]61. Carpenter, J.; Jackson, C.; Behrens, L. INCENTIVES + SOCIAL MEDIA RECRUITMENT + MINIMAL SUBJECT INTERACTION= POTENTIAL FOR FRAUD! Innov. Aging 2023, 7, 354. [CrossRef]Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individualauthor(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury topeople or property resulting from any ideas, methods, instructions or products referred to in the content.
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chronic illness experience
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cancer
sepsis
rehabilitation
patient education
A Qualitative Study Exploring the Rehabilitation Experience of Individuals with a Previous Diagnosis of Cancer and/or Sepsis, Their Caregivers, and Health Providers
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