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How Receptive Are Patients With Late Stage Cancer to Rehabilitation Services and What Are the Sources of Their Resistance?

Published:August 31, 2016DOI:https://doi.org/10.1016/j.apmr.2016.08.459

      Abstract

      Objective

      To describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, and the rationale for their level of interest.

      Design

      Prospective mixed-methods study.

      Setting

      Comprehensive cancer center in a quaternary medical center.

      Participants

      Adults with stage IIIC or IV non–small cell or extensive stage small cell lung cancer (N=311).

      Interventions

      Not applicable.

      Main Outcome Measures

      Telephone-acquired responses to the administration of (1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); (2) numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; (3) a query regarding receptivity to receipt of rehabilitation services, and (4) a query about rationale for nonreceptivity.

      Results

      Overall, 99 (31.8%) of the study's 311 participants expressed interest in receiving rehabilitation services: 38 at the time of enrollment and an additional 61 during at least 1 subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs 9.91%, P=.04) and a musculoskeletal comorbidity (42.4% vs 31.6%, P=.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns.

      Conclusions

      One-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.

      Keywords

      List of abbreviations:

      AM-PAC-CAT (Activity Measure for Post Acute Care Computer Adaptive Test), NRS (numerical rating scale), PRO (patient-reported outcome)
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