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Abstract

Exercise can improve physical function and treatment-related impairments for those with cancer. Though exercise is a well-established supportive care strategy, without tailored support, people living with advanced lung cancer rarely meet exercise recommendations and few exercise programs are tailored to their needs. This thesis project investigates the barriers and facilitators to the implementation of the “Mitigation of decline with Virtual Exercise for lung cancer (MoVE)” program from the perspectives of relevant interest-holders. Semi-structured interviews were conducted with 27 participants across five participant groups: 1) MoVE participants; 2) exercise intervention providers; 3) referring healthcare providers; 4) oncologists; and 5) organization decision-makers. These interviews were analyzed through directed qualitative content analysis using the Consolidated Framework for Implementation Research 2.0 (CIFR 2.0) to identify barriers and facilitators to implementation. Sub-themes were identified, which specified actions that may be relevant to the implementation process. From these sub-themes, three key systems-level themes emerged. First, many clinic settings are not prepared to implement MoVE as the program currently exists, due to funding and staffing shortages. Second, while the siloed healthcare system poses challenges to implementation, leveraging organizational structure and fostering relationships in the referral pathway can contribute to the success of these types of supportive care programs. Finally, while there is growing recognition of the importance of supportive care, especially exercise, in cancer care, supportive care struggles to find priority amongst other clinical tasks or innovations in the cancer care system. This study provides insight into the considerations that need to be made in the implementation of an exercise program for people with advanced lung cancer based off MoVE. The identification of barriers and facilitators for implementation are the first steps in developing a comprehensive and sustainable implementation plan.