Realist informed mixed-methods evaluation of cancer rehabilitation services in South Wales

Csontos, Judit ORCID: https://orcid.org/0000-0003-4597-3052 2021. Realist informed mixed-methods evaluation of cancer rehabilitation services in South Wales. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background: Cancer rehabilitation, which can comprise exercise and dietary advice among other interventions depending on people’s needs, has been found to improve quality of life worldwide. However, in Wales, 41.3% of Welsh Cancer Survey respondents reported receiving no or limited support with their rehabilitation needs. The reasons for this insufficient support are uncertain. The broad aim of this study was to investigate what works in two cancer rehabilitation services, for whom, in what circumstances and how. Methods: Realist evaluation (RE) informed the study design, as RE seeks to answer the question of what works, for whom, in what circumstances and how with the development of context-mechanism-outcome (CMO) configurations. Based on RE principles, first four initial cancer rehabilitation theories were developed through literature review and consultation with experts. The initial theories were tested with mixed methods: quantitative secondary analysis of routine cancer rehabilitation data; and qualitative, one-on-one, semi-structured interviews (n=35) with healthcare professionals and people with cancer. Findings: Testing the four initial theories which focused on information provision, healthcare professionals’ training, individualised care, and cancer rehabilitation interventions showed that services did not always work as hypothesised. Numerous contexts inhibited information provision, healthcare professionals’ training and cancer rehabilitation, for example, the medical model, healthcare professionals’ lack of time, accessibility concerns, and insufficient needs assessment, leading to fluctuations in service uptake, staff capacity issues and people’s unmet health needs. Moreover, professional boundaries were identified as mechanisms influencing cancer rehabilitation provision. However, well managed therapeutic relationships, family and “spontaneous” peer support aided the provision of individualised, tailored cancer rehabilitation interventions resulting in people’s improved quality of life and self-management. Conclusion: Cancer rehabilitation services in South Wales have the potential to help people cope with cancer and improve quality of life. However, several contexts hinder service provision, which needs addressing for optimal cancer rehabilitation.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Healthcare Sciences
Date of First Compliant Deposit:	20 October 2021
Last Modified:	10 Nov 2022 09:55
URI:	https://orca.cardiff.ac.uk/id/eprint/144947

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