Abstract
Purpose. Multidisciplinary rehabilitation programmes providing exercise, nutrition support, education, and peer support can effectively meet the rehabilitation needs of upper gastrointestinal (UGI) cancer survivors. This study aimed to explore the experiences of participants who engaged in a telehealth, multidisciplinary rehabilitation programme for UGI cancer survivors. Methods. This single-arm feasibility study recruited participants who completed curative treatment for UGI cancer. Participants (n = 10, male = 9) aged 58–76 years were 5–17 months postsurgery. A 12-week telehealth rehabilitation programme was delivered via video call, consisting of group resistance training, remotely monitored aerobic training, 1 : 1 dietary counselling, 1 : 1 physiotherapy support, and group education sessions. Independent researchers conducted semistructured interviews at postintervention assessments. Transcripts were analysed using reflexive thematic analysis (RTA). Results. RTA of participant transcripts generated three overarching themes: (1) ReStOre@Home impacted psychosocial and physical needs by addressing a broad and meaningful gap in services, (2) paving a pathway towards prosperity, and (3) contrasting experiences with using technology. Participants’ preferences and recommendations for future telehealth programmes were discussed. Conclusions. A telehealth multidisciplinary rehabilitation programme supported participants in physical and psychosocial recovery. Qualitative analysis identified an important ongoing need for some in-person care and provided detailed insights into participant experiences during telehealth-delivered rehabilitation.
1. Introduction
Improvements in upper gastrointestinal (UGI) cancer diagnosis and treatment have led to an increasing number of people living with and beyond UGI cancer and, therefore, a growing global population of people living with the consequences of UGI cancer treatment [1, 2]. The intended curative treatment combinations of surgery, chemotherapy, and/or radiation therapy for UGI cancers are associated with a high rate of complications [3, 4]. Two thirds of patients experience long-term treatment side effects [4], with fatigue (41%), problems sleeping (51%), and eating restrictions (49%) as the most common long-term symptoms reported one year postoperation [5]. Pain, dyspnoea, anxiety, low mood, reduced cardiovascular fitness, and reduced physical function are further wide-ranging and common side effects of treatment which negatively impact physical and psychosocial functioning and health-related quality of life (HR-QOL) [3–10]. A 76% incidence rate of malnutrition among oesophageal cancer patients preoesophagectomy [11], and of 38% postoperatively, indicates the need for dietetic support among this group [12], who suffer with issues relating to food intake and digestion [10], malabsorption [13], and weight loss [4] posttreatment. Following treatment, 74.2% of oesophageal cancer survivors report needing to modify their eating habits, with 50.8% reporting negative consequences for social functioning [4].
The complex physical, nutritional, and psychosocial rehabilitation needs of people following treatment for UGI cancer require early and ongoing intervention. There is strong evidence that exercise can help manage many of the physical and psychological side effects of cancer treatment, including pain, fatigue, depression, and anxiety, and can improve cardiovascular fitness, physical function, and HR-QOL [14–16]. Furthermore, nutritional counselling is an important aspect of rehabilitation for UGI cancer [11] due to the high incidence of malnutrition and related complications [17].
Multidisciplinary interventions combining exercise, nutritional counselling, and education are an effective way to provide rehabilitative support to people following UGI cancer treatment [18, 19]. The Rehabilitation Strategies for Oesophageal Cancer (ReStOre) multidisciplinary programme [19] is a 12-week intervention that is shown to improve cardiorespiratory fitness and HR-QOL for oesophagogastric cancer survivors, without compromising body composition. ReStOre incorporates group-based resistance and aerobic training and education sessions with one-to-one dietary consultations and support calls delivered by healthcare professionals, including physiotherapists and dieticians; in-person, on-site research studies, based in a cancer specialist hospital in Dublin city, resulted in improved cardiovascular fitness without compromising body composition. Participants reported improved self-confidence and reduced isolation and benefited from building relationships and sharing experiences with other participants [16]. A definitive randomised control trial (RCT) of the ReStOre programme (ReStOre II) was due to begin recruitment in spring 2020 but was put on hold due to the COVID-19 pandemic [20].
Throughout the COVID-19 pandemic, telehealth was used by cancer rehabilitation services to overcome the restrictions placed on meeting in person and exercising in groups indoors [21–23]. Telehealth has been shown to be safe, acceptable, and feasible for delivering rehabilitation to people during and after their cancer treatment [22, 23] and, therefore, was a potential solution for delivering the ReStOre programme, while in-person services were disrupted. However, it was unknown how well a multidisciplinary rehabilitation programme, involving multiple components and a variety of sessions, would adapt to an online delivery model. To investigate the feasibility of an online model of the ReStOre programme, we converted the ReStOre II protocol to a model of online delivery, titled ReStOre@Home [24].
The 12-week ReStOre@Home feasibility study ran from July to October 2021. Feasibility findings, reported by Brennan et al. [25], demonstrate that the online model was convenient and acceptable, had high levels of attendance, and had high levels of participant satisfaction with the telehealth system and mode of delivery. While these findings provide insights into the suitability of a telehealth intervention for improving postoperative health and well-being among this cohort, less is known about participant experiences of participating in this novel rehabilitation programme. Listening and learning from patient experiences in healthcare is essential to ensuring services are patient-centred and meet service users’ needs [26–28]. There are few qualitative studies of multimodal telerehabilitation programmes for cancer survivors, with research in this area primarily focusing on exercise (e.g., [22]) or occupational telerehabilitation (e.g., [29]). Thus, this research is novel in its exploration of the experiences of an MDT programme encompassing exercise, nutrition, and education. It is therefore imperative to understand participants’ experiences, perceptions, and attitudes towards RestOre@Home and, more broadly, to better understand their experiences of telehealth MDT cancer rehabilitation interventions.
Qualitative research methods are valuable for exploring and understanding patient experiences [30], and previous qualitative work has helped inform the design and delivery of the ReStOre programme [13]. As the restrictions associated with the COVID-19 pandemic are lifted and the larger ReStOre II RCT resumes, it is important to understand participant experiences of telerehabilitation to evaluate impact and better meet patient needs [31]. This qualitative study therefore aims to explore the experiences and perspectives of participants in a telehealth multidisciplinary cancer rehabilitation programme (ReStOre@Home).
2. Methods
2.1. Study Design
This qualitative descriptive study was underpinned by critical realist philosophical positioning that encourages listening and learning from lived experiences to understand a phenomenon. Semistructured interviews were used to gather detailed descriptions of participants’ experiences and perceptions of ReStOre@Home [32]. The 6-step process of reflexive thematic analysis (RTA) outlined by Braun and Clarke was applied [33, 34]. RTA is an analytic method commonly used in qualitative health research [35] and supports interpretivist approaches to qualitative data generation. Its iterative process facilitates exploration of meaning across a dataset to enhance understanding of participants’ shared experiences [36]. Findings are reported as per the standards for reporting the qualitative research (SRQR) checklist [37] to ensure transparency in reporting [38].
2.2. Ethical Approval
Ethical approval for this study was granted on August 20, 2020, by the St. James’s Hospital (SJH)/Tallaght University Hospital (TUH) Research Ethics Committee. This study was performed in line with the principles of the Declaration of Helsinki.
2.3. Participants and Recruitment
Individuals who had completed curative treatment for oesophageal or gastric cancer and were medically fit to participate in exercise were invited to take part in the ReStOre@Home study. Full details of participant screening, recruitment, and retention for ReStOre@Home are available by Brennan et al. [25]. During formal recruitment to the ReStOre@Home study, participants were provided with a participant information leaflet and consent form relating to qualitative interviews following the trial. Twelve participants provided informed written consent and were recruited to the study. Of these 12 participants, two withdrew from the trial at an early stage due to ill health and work commitments and were therefore not contacted for follow-up interviews. One participant withdrew from the trial after two weeks due to issues using the required technologies; as their withdrawal was related to the format of the intervention, they were invited to complete an interview at this timepoint to share their experiences using the technologies.
2.4. Intervention
The ReStOre@Home programme is a multidisciplinary and multicomponent telehealth rehabilitation programme for survivors of UGI cancer [24], delivered via video call using the Digital Therapeutics Platform created by Salaso Health Solutions Ltd. (Kerry, Ireland). Adapted from the in-person ReStOre programme [19], it consists of group aerobic and resistance training, education sessions, and one-to-one dietary counselling. Aerobic training is remotely monitored using Polar M200 heart rate monitor watches and the Polar Flow smartphone application (Polar Electro Oy, Kempele, Finland). Programme components are further detailed in the study protocol [24], and quantitative findings are reported by Brennan et al. [25].
2.5. Data Collection
Participants were invited to take part in semistructured interviews scheduled for the week after the intervention finished. Interviews were facilitated by researchers LON or DC using the interview guide informed by the literature (see Table 1). LON is a female physiotherapist, and DC is a female occupational therapist; both have extensive experience in qualitative research methods and cancer survivorship. Participants did not have a preestablished relationship with the facilitator prior to the interview. Only the facilitator and the participant were present for the interviews, which were audio-recorded using Dictaphone with the participant’s consent. Audio files were uploaded onto a protected server that only members of the research team had access to and deleted from Dictaphone.
2.6. Data Analysis
Transcripts were transcribed verbatim, anonymized, and analysed independently by three researchers (AOB, LB, and LON). AOB is a research assistant with an undergraduate and postgraduate degree in psychology, and LB is a Research Fellow and Chartered Physiotherapist; both are experienced qualitative researchers, and LB has further research and clinical experience in cancer survivorship. Analysis was carried out using the RTA process outlined in Figure 1. First, AOB, LB, and LON engaged in data familiarisation by reading and rereading transcripts and noting down initial thoughts. Second, AOB and LB began to independently code the data by systematically reviewing the entire dataset to identify distinct quotes which were insightful, informative, and related to the research aims. They then generated the initial codes for the whole dataset, i.e., words and phrases that captured the meaning and context of one or several quotes. AOB and LB met to review and discuss the preliminary analysis and jointly conducted a second iteration of coding, which involved developing, merging, or eliminating codes to best identify patterns of meaning across the data related to the research question. Codes were grouped together to develop preliminary themes, a process visually mapped in Figure 1.
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Next, all researchers (AOB, LB, and LON) met to review and discuss the codes and preliminary themes. Through discussion and reflection, they refined and consolidated the themes and created theme names; overlapping themes were combined until themes were deemed discrete. Final codes and themes were discussed to consolidate perspectives from all researchers.
The reflective aspect of RTA allowed us to identify and explore our perspectives on the dataset. Using multiple coders encouraged further reflection, exploration of assumptions, and collaborative interpretation of the data [34, 39], with the introduction of an independent coder with a background in health psychology (AOB) further enabling multidisciplinary perspectives in the analysis. The final phase of RTA involved the selection of key quotes to represent each theme and the discussion of findings in relation to the research question and relevant literature.
3. Results
Ten participants took part in semistructured interviews. Interviews were performed over the phone (n = 3) and in person (n = 7) at the SJH Clinical Research Facility and lasted between 15 and 37 minutes. Participant group characteristics and individual characteristics are detailed in Table 2. The male-dominated sample in this study reflects the demographics of oesophageal cancer.
Reflexive thematic analysis of the interview transcripts generated three overarching themes, which are seen with their corresponding subthemes and codes in Table 3.
3.1. Theme 1:
ReStOre@Home Impacted Psychosocial and Physical Needs by Addressing a Broad and Meaningful Gap in Services
3.1.1. Challenges with Recovery Prior to ReStOre@Home
Participants described feeling uncertain about how to self-manage their recovery upon discharge from hospital and acute clinical care. Despite receiving guidance from healthcare professionals during the acute period of care, participants reflected that they did not feel equipped to independently manage their recovery:
“It’s sort of “thanks very much, good luck, you’re on your own again”” P02.
Feelings of loneliness and isolation were commonly experienced by many participants:
“Before the programme you feel you’re out there on your own… after (the surgery), nothing… and then you go home, and that’s it-“what do I do now?” So there was a bit of that loneliness” P09.
Participants found it difficult to manage symptoms that were impacting their return to normal day-to-day activities (e.g., stomach pain, fatigue). Despite wanting to return to normal routines, participants struggled to adapt:
“I said, ok, time to start getting back into the swing of things. There were a few leaves in the garden, and I tried to sweep them up. After a minute I had to tell my wife I’m going to bed, I can’t, I’m exhausted. And I was exhausted” P06.
3.1.2. Feelings of Connectedness with Peers and Professionals
The virtual programme was a safe opportunity to meet others with shared symptoms and experiences of recovering from UGI cancer. This was particularly felt during the group-based education sessions, where participants discussed their experiences of recovery:
“I think you knew that you were meeting people of your own ilk, in the same situation or similar situation. And we all had the same common denominator, which was to get yourself better… I found, for me, it kept me connected…You know you’re not alone” P07.
The group video calls facilitated rapport and relationships among the group, creating a sense of community and comradery—an antidote to the loneliness and isolation experienced by participants prior to the programme:
“I used to enjoy the exercise and also the little chat before the start. The lads would be there. And it’s nice to hear their side” P10.
The importance of compassionate care in cancer recovery was emphasized by participants. Participants felt supported by, connected to, and cared for by the clinical staff facilitating the programme, whom they could speak with openly and intimately:
“I think [researcher)] has a lovely way about her. Engaging, pushing you on, and communicating, which, besides all her professional skills, I think that really helped. That’s what I mean about the caring element of it” P11.
3.1.3. Personalised Care Meeting and Supporting Individual Needs
Participants viewed ReStOre@Home as a programme providing continuity of care. For many, it addressed the service gap between active treatment and the posttreatment survivorship period:
“The feeling that there was a connection still with the hospital was a big thing, that you were not just running out the door and kind of forgotten about… You felt you had a connection still with the clinical team” P12.
After surgery, many participants were nervous about engaging in activities or services without clearance from clinical specialists. Participants were grateful for a programme that was designed and tailored specifically for those living with and beyond UGI cancer with a specialist clinical research team familiar with their unique symptoms and support needs:
“I was kind of a bit anxious about going to a physio myself, and having to explain things again and again. Would they do more damage than anything? So it was great when this popped up, because they knew my history, and it was geared towards people who had surgeries like me” P09.
Additionally, the clinical team could personalise the programme to each participant’s needs, which was appreciated by P09:
“I hurt my back just as the programme was getting going… The guys were able to help me with that. They took some exercises off that would have been detrimental to the back, we did it that way, it was great” P09.
The personalised programme inspired positive behaviour change among participants, who hope to maintain these behaviours outside of the programme:
“I got a huge amount out of my one-to-one today. I know where I’m going, I’ve something positive to work on. And I hope to maximise that” P04.
Some participants requested that the clinical team provide long-term follow-up sessions to encourage participants to continue progressing towards a future goal after the programme finished and facilitate the feeling of being cared for and supported despite the programme ending:
“I just think it is important that there’s a follow-up… Even a phone call, just to see how you’re getting on. If there’s another programme going on, maybe people would like to go on that. Because you’ve kick-started people at this, they’re in drive at the moment, there’s no point putting them back in parking” P02.
3.2. Theme 2: Paving a Pathway towards Prosperity
3.2.1. Improved Physical and Mental Health
After completing ReStOre@Home, participants described having improved fitness and strength, and feeling more energised and less fatigued:
“Energy levels have improved and fatigue levels have reduced, definitely. It might be 75% of preoperation levels before the programme and I would say I’m up to 90–95% of energy levels now” P01.
As they became stronger, participants were motivated to physically push themselves further than before:
“They said they wanted my heart rate up, and that was it, I gave them enough of heart rate up, running around the park… They were trying to make my heart stronger, and they did” P05.
Participants enjoyed attending and completing the exercise classes and described both short- and long-term benefits to their mental well-being. P05 spoke enthusiastically about the walking programme:
“It wasn’t that I had to do it, I wanted to do it. I loved doing it.” P06 shared the “feel-good factor” he got from resistance training: “I always felt good after.”
The combination of exercise, nutrition, and education improved overall well-being, as participants were equipped with knowledge and tools to enhance self-management of their symptoms during recovery:
“I built up confidence. I’m very confident again now. I don’t worry about anything much. Things that would have worried me one time doesn’t bother me anymore” P05.
Participants described feeling an improved sense of purpose and were motivated to take important next steps in their recovery journey:
“I have a very clear roadmap or direction about what I need to do… that peace of mind” P11.
As participants became more aware of the physical and psychological factors that impacted their recovery, a suggestion arose for future ReStOre programmes to include education sessions tailored towards understanding these changes and the psychological supports that they could access outside of the hospital:
“I think it might be worth explaining again what change has happened to your body in simple English… your stomach and your diaphragm… Maybe I’m wrong, I’m not so sure everybody fully understood that” P11.
“A little bit more on psychology and the availability of counselling… that could be worthwhile” P01.
3.2.2. Returning to Meaningful Activities
As participants became more comfortable exercising independently, they felt more confident in their physical abilities and capabilities. The skills and abilities developed throughout the programme helped participants return to meaningful activities and participate more fully in daily life:
“It gave me more confidence, because when you’re out of the hospital, they say “take it easy, sit down” and I found that wasn’t necessarily the right thing to do. I found it’s no harm to do a bit of exercise and push yourself a little bit” P12.
Several participants applied newfound self-management advice to effectively manage nutrition-related symptoms. P11 shared how dumping syndrome was negatively impacting his daily life and that symptoms improved markedly throughout the programme:
“Three times a week I had some sort of incident, a bad day. The repercussions of that is that you’re feeling weak, you don’t want to feel like going walking as much, your nutrients are gone, you’re tired… It’s once a week now, and even it’s a lot less in severity” P11.
Improved symptom management equipped participants to return to participating in professional, social, and self-care activities:
“I went back to work. Not full time, but part time, and that was brilliant” P05.
“I’d be more proactive in doing things in the house. I used to cook a lot, not particularly exciting dishes. I started to do [cooking] in the last two or three weeks” P06.
3.3. Theme 3: Contrasting Experiences with Using Technology
Almost all participants provided strong positive feedback for the online model of care, reporting that it reduced commute times, increased accessibility for those outside of Dublin, and kept participants safe from exposure to the COVID-19 virus:
“For me, everything remote is good. I think most patients would absolutely prefer the logistics of doing it at home… I think it makes it feasible” P01.
However, telehealth was not appropriate for every participant. Participant04 reluctantly withdrew from the study as they found the telehealth delivery “just wasn’t working for me”:
“I don’t think it’s going to suit my situation because my big problem is our broadband… I think it’s a nonrunner for me” P04.
Participants with less experience using technology were apprehensive about using digital tools, such as the heart rate monitor watch and the tablet. Participant04 described themselves as “not computer literate,” and therefore, the technology was “very difficult to handle.” Of those that found the telehealth model an acceptable mode of delivery but struggled using the technologies, support from family was essential to completing the virtual calls during the programme:
“My daughter would log in when the time came for you to join … I didn’t touch, I just let her, I could knock the whole bloody thing over because I don’t know what I’m doing” P10.
There were contrasting experiences with the heart rate monitor watches; some participants found it difficult to use the new device, while others found the technology useful for tracking progress and meeting goals:
“The polar watches are a bit clunky, to be honest, a bit old, you have to do a lot of pressing, you can’t do it on-screen” P09.
“I kind of got used to using the watch all the time to be honest with you. It was very good for the walks, it was simple to use… It was very user-friendly” P12.
For future programmes, some participants recommended including a technology-focused training session at the programme onset, to familiarise participants with the technologies and to build self-confidence in using the technologies independently:
“An education session on the watch should be included…just how to use that, to give tips and tricks and that kind of stuff” P09.
Some participants missed the social aspect of an in-person programme and expressed desire for future programmes to follow a hybrid model, with some online and some in-person sessions. This would provide participants with the opportunity to physically meet others on the programme and strengthen relationships forged online:
“Try and have it so that after the first couple of weeks, everybody comes in and meets” P02.
Importantly, those who found telehealth delivery a barrier to participation in the programme would be “prepared to try” (P04) the in-person ReStOre programme.
4. Discussion
This study explored the experiences and perspectives of UGI cancer survivors who took part in the ReStOre@Home multidisciplinary and multicomponent virtual rehabilitation programme [25]. Reflective thematic analysis of the interview transcripts generated three overarching themes: (1) ReStOre@Home impacts psychosocial and physical needs by addressing a broad and meaningful gap in services, (2) paving a pathway towards prosperity, and (3) contrasting experiences with using technology.
The postoperative cancer recovery journey was identified as an isolating period by participants. Previous qualitative research exploring oesophageal cancer survivors’ experiences of navigating the cancer recovery journey has found that this group struggles to identify formal support services tailored to their particular needs [13]. Loneliness is indeed common among people with and after UGI cancer, who may struggle to meet others with similar experiences [13, 16]. Participants of the previous in-person ReStOre programme described an open and fun atmosphere among the group, developing meaningful relationships with others with shared experiences of cancer [16]. A key finding of the current study was that, similarly, participants described the online programme as a source of social support, connecting them with other UGI cancer survivors at a time when it was difficult to meet others. A systematic review and narrative synthesis of cancer survivors’ experiences of telehealth found that participants in 9/22 studies deemed telehealth an impersonal medium that lacked physical presence [31]. It is possible that our findings contrast with previous literature suggesting that telehealth is an impersonal mode of delivery [31, 40] as this study was carried out during COVID-19, when social distancing guidelines led to an inability to meet and connect with others [41]. The social benefits of this programme were therefore heightened as people were deprived of social contact and connectedness during this time. ReStOre@Home participants forged personal connections online; they similarly shared a desire for an in-personal element to the programme, at the beginning or end, to consolidate online connections.
Some findings in the broader literature suggest that patients may perceive telehealth as inhibiting meaningful patient-practitioner interactions [42–44]. Dennett et al. [22] describe the importance of personal connections between staff and patients, which can be disrupted by a telehealth programme. ReStOre@Home participants report receiving meaningful and compassionate care from clinicians through video calls; this may have been aided by the comparatively high frequency of contact with staff and other participants in this multicomponent programme. Crucially, much of the literature in this field reports on telehealth interventions delivered during the COVID-19 pandemic, when participants were already experiencing considerable isolation due to lockdowns. Social interaction and connection with those attending or delivering an online physical rehabilitation programme have been identified as important to those less receptive to using technology [45]. Offering a hybrid approach provides increased choice for those who may benefit from the flexibility and conveniences of telehealth while allowing for an in-person component when needed [46–48]. For those living with and beyond cancer, telehealth was a highly satisfactory approach to delivering care and is an acceptable option postpandemic [49]. Future studies conducted during a postpandemic period may better explore the impact and importance of social connectedness for participants in telehealth rehabilitation alongside measures of attendance, satisfaction, and physical activity.
Working with a patient group with minimal rehabilitation support may explain why ReStOre@Home was highly valued by participants, as it is a programme designed and developed to specifically support the needs of people recovering from UGI cancer. Furthermore, it successfully assisted in their return to meaningful activities. This promising finding aligns with previous research describing exercise only telerehabilitation as “a good stepping stone” in supporting participants in their return to normal physical activity participation [50]. The benefits of the telehealth model can be classified using the health components of the World Health Organisation’s International Classification of Functioning (ICF) [51], a framework conceptualising health and disability and their impact on functioning. Core dimensions of the framework include bodily function and activity/participation, two domains that are heavily impaired during postoperative recovery [3, 9]. Socialising is a challenging aspect of postoperative recovery due to physical impairment and difficulty managing symptoms [9, 13]. With a multidisciplinary team supporting their individual needs, participants of this multidisciplinary telehealth programme successfully returned to engaging in physical activity as well as social, personal, and professional activities. Participants described improved functioning, participation in meaningful activities, and better management of activities of daily living at the end of their 12 weeks.
While virtual delivery of the rehabilitation programme was an acceptable and enjoyable experience for the majority of participants, some struggled with using the digital equipment. Poor digital literacy is a barrier to the successful implementation of telehealth [52], and assistance from family members was essential to enable some participants to successfully use the digital tools. While digital health can improve access to cancer care, researchers and healthcare practitioners must make concerted efforts to include people with all levels of skill through education, targeted design, and inclusive implementation strategies [40, 53]. Acting on participant feedback regarding digital equipment and applying user-friendly, intuitive design can improve participant uptake and adherence to telerehabilitation [54]. Future hybrid programmes should include an education session on how to use the digital equipment before beginning the rehabilitation programme to help build participant confidence in their digital skills. Additionally, future programmes could screen the participant’s level of digital skills through their ownership and use of a smart device [55, 56] rather than access, as this is a strong indicator of participant willingness to use telerehabilitation [55].
4.1. Strengths and Limitations
A strength of this qualitative study is the methodological rigor, which was achieved by using interview facilitators that were not associated with the trial delivery, allowing for an open and honest dialogue between interviewers and interviewees, as well as following the RTA process, using multiple, experienced researchers, and adhering to SRQR guidelines [36]. The participants represented a wide age range within this cancer type and provided insight into their postoperative recovery journey at multiple timepoints. Additionally, variation in participants’ digital literacy can also be seen as a strength of this study, as those with fewer digital skills and who are older are less likely to participate in research exploring digital healthcare; thus, this sample of participants is less represented in healthcare research [57, 58]. Study limitations include the absence of interview data from two participants who did not complete the rehabilitation programme and the lack of longitudinal qualitative data. Both limitations should be addressed in future protocols to better understand the long-term impact of the programme, the barriers and facilitators impacting participant engagement, and the gathering of more critical feedback of the trial.
4.2. Implications for Research and Practice
This research demonstrates a general acceptability of and satisfaction with the telehealth delivery of a multicomponent cancer rehabilitation programme while also highlighting some key recommendations for future programmes. Importantly, virtual delivery of the programme met a holistic range of participant needs in a cohort with broadband internet access and adequate digital skills. A future cancer rehabilitation programme should consider including some aspects of in-person care within the intervention and thorough education sessions around any technologies used. Based on the current findings and those from our feasibility study [25], the next wave of ReStOre (ReStOre II) will build on the findings of this research and will offer both a fully in-person programme, as well as a hybrid model, which involves a mixture of in-person and online sessions, to meet all patient needs.
The importance of peer support, social interaction, and relationships among those participating in cancer rehabilitation programmes is demonstrated in these findings. Future research could explore the importance of relationships forged during in-person specialist cancer rehabilitation programmes compared to those forged online, to investigate the impact on participant experiences.
5. Conclusions
This study explored the experiences and perspectives of UGI cancer survivors who took part in ReStOre@Home, a telehealth model of the ReStORe 12-week multidisciplinary rehabilitation programme. Participants experienced improved mental and physical well-being and achieved successful returns to participation in professional, social, and self-care activities. The telehealth model of delivery was found to be acceptable to participants, but some relied on family assistance to utilise the technologies. Participants benefited from meeting other UGI cancer survivors and sharing experiences of treatment and recovery, and they were also able to develop meaningful relationships with staff. Future research should explore factors influencing participant attrition to enhance the accessibility of ReStOre and maximise engagement and should include a longitudinal component to explore the long-term impact of the programme on participant health and well-being.
Data Availability
The data used to support the findings of this study are available from the corresponding author upon request. Repository name: SRQR checklist for “Participant experiences of a telehealth multidisciplinary cancer rehabilitation programme: qualitative findings from the ReStOre@Home feasibility study” (https://osf.io/z9e5p/?view_only=9d4fb41a3264482cac657cce69266589).
Disclosure
The HRB has no direct role in the design, conduct, or analysis of this research.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Acknowledgments
The authors extend their thanks to the participants who generously gave their time to this research, Sinead King, Upper Gastrointestinal Cancer Database Manager at SJH, for her generous support with recruitment, Salaso Health Solutions Ltd. for being a technology partner on this project, and the charity partners, the Irish Cancer Society and the Oesophageal Cancer Fund, their patient, and public representatives. The authors appreciate the support of the Wellcome Trust/Health Research Board Clinical Research Facility at SJH in providing an environment to conduct high-quality research. This research was funded by the Health Research Board (HRB) Ireland Definitive Intervention and Feasibility Award (DIFA-2018-009).