“I had to figure this out for myself.” Patients and healthcare professionals’ perspectives on rehabilitation uptake after treatment for head, neck and lung cancer: a qualitative interview study

Background. Rehabilitation is known to have many positive effects for cancer patients. However, patients with head, neck and lung cancer generally have a low uptake of rehabilitation. Therefore, the aim of this study was to explore patient and healthcare professionals’ perspectives on rehabilitation uptake after treatment for head, neck and lung cancer in a municipal setting. Methods. Semi-structured formal interviews were conducted with patients and healthcare professionals across hospital and rehabilitation settings in northern Denmark. All interviews were transcribed verbatim and analyzed using reflexive thematic content analysis. Results. There are multiple factors underlying the low uptake of rehabilitation for head, neck and lung cancer patients, ranging from systemic barriers, to matters of health (i)literacy and a perceived lack of interest, which upon further reflection often masks a deeper existential and/or physical vulnerability. Discussion. Our findings indicate that while many of the barriers to rehabilitation uptake arise in the transitions between care sectors, there is also a need to rethink how rehabilitation fits into the cancer care trajectory at hospital level. Current praxis leaves many opportunities for inequalities in rehabilitation access and uptake to arise. Currently, patients hold much of the responsibility for seeking out information about, and coordinating access to, rehabilitation.Increasing hospital-based healthcare professionals’ awareness of the proven positive outcomes of rehabilitation, coupled with more workable cross-sectoral procedures would improve organizational health literacy, making it easier for patients to navigate and could increase the uptake of rehabilitation among head, neck and lung cancer patients.Logistical barriers to rehabilitation uptake deter some patients, especially when coupled with fatigue and other physical symptoms resulting from their disease and/or treatment, and rehabilitation programs should be designed with these barriers in mind. Currently, patients hold much of the responsibility for seeking out information about, and coordinating access to, rehabilitation. Increasing hospital-based healthcare professionals’ awareness of the proven positive outcomes of rehabilitation, coupled with more workable cross-sectoral procedures would improve organizational health literacy, making it easier for patients to navigate and could increase the uptake of rehabilitation among head, neck and lung cancer patients. Logistical barriers to rehabilitation uptake deter some patients, especially when coupled with fatigue and other physical symptoms resulting from their disease and/or treatment, and rehabilitation programs should be designed with these barriers in mind.