Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite extensive research in the field and an enhanced focus on BC rehabilitation, up to 34–43% of these patients are at risk of developing chronic distress. In addition, it is known that these patients repeatedly report unmet needs, which are strongly associated with reduced quality of life. However, despite knowledge that patients’ needs for support during BC rehabilitation varies greatly, individualized rehabilitation is often lacking. Therefore, this study aimed to explore health care professionals’ (HCPs) experiences of current rehabilitation practice and describe current barriers and facilitators for individualized rehabilitation for patients following BC treatment. A total of 19 HCPs were included, representing various professions in BC care/rehabilitation within surgical, oncological and specialized cancer rehabilitation units at a university hospital in Sweden. Five semi structured focus group interviews were conducted and inductively analysed using conventional qualitative content analysis. Three categories were captured: (1) varying attitudes towards rehabilitation; (2) incongruence in how to identify and meet rehabilitation needs and (3) suboptimal collaboration during cancer treatment. The results showed a lack of consensus in how to optimize individualized rehabilitation. It also illuminated facilitators for individualized rehabilitation in terms of extensive competence related to long-term experience of working with patients with BC care/rehabilitation. Further, the analysis exposed barriers such as a great complexity in promoting individualized rehabilitation in a medically and treatment-driven health care system, which lacked structure and knowledge, and overarching collaboration for rehabilitation. This study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today’s BC trajectory. It also reveals that structures for systematic screening for needs, evidence-based guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking. To enable optimal and individualized recovery for BC patients’, rehabilitation needs to be an integrated part of the cancer trajectory and run in parallel with diagnostics and treatment.

中文翻译：

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乳腺癌治疗期间个体化康复的障碍和促进者–焦点小组研究，探索医疗保健专业人员的经验

乳腺癌（BC）和相关治疗与发生多种持续性致残障碍的风险有关。尽管在该领域进行了广泛的研究并且更加关注BC康复，但是这些患者中仍有高达34–43％的患者有患慢性病的风险。另外，已知这些患者反复报告未满足的需求，这与生活质量下降密切相关。然而，尽管知道患者在BC康复期间对支持的需求差异很大，但通常仍缺乏个体化的康复。因此，本研究旨在探讨卫生保健专业人员（HCP）当前康复实践的经验，并描述BC治疗后患者进行个体化康复的当前障碍和促进者。总共包括19个HCP，代表瑞典一家大学医院的外科，肿瘤科和专门癌症康复科的BC护理/康复的各个专业。进行了五次半结构化焦点小组访谈，并使用常规的定性内容分析进行归纳分析。分为三类：（1）对康复的态度各异；（2）在确定和满足康复需求方面不一致，以及（3）在癌症治疗过程中合作不够理想。结果表明在如何优化个性化康复方面缺乏共识。从与长期服务于BC护理/康复患者的长期经验相关的广泛能力方面，它也为个性化康复提供了便利。进一步，该分析暴露了障碍，例如在医疗和治疗驱动的医疗保健系统中促进个性化康复的复杂性很强，因为缺乏结构和知识，并且无法实现全面的康复合作。这项研究表明，癌症的发展轨迹是由医学和治疗驱动的，而康复在当今的BC发展轨迹中仅扮演着重要的角色。它还表明，缺乏系统的需求筛查结构，基于证据的个体化康复干预指南以及缺乏将患者转介至晚期康复的结构。为了使BC患者获得最佳的个性化康复，康复需要成为癌症治疗过程中不可或缺的一部分，并与诊断和治疗并行进行。