Oncología clínica: informes de casos

Barriers and Facilitators to the Referral of Patients with Cancer for Physiotherapy Rehabilitation: A Uganda Cancer Institute (UCI) Case Study

Denis Nareeba*, Bonita Ainembabazi, Derrick Asiimwe, Gift Atuhaire, Kenneth Pascal Ochom, Wilfred Arubaku,  Jean Damascene Niyonsenga

Background: Cancer and its treatment are linked to a variety of physical complications. Physiotherapy is recommended as the treatment of choice for improving cancer patients' physical function and quality of life. Patients with cancer and rehabilitation needs at Uganda Cancer Institute (UCI) receive inadequate physiotherapy services. There is little information available about the factors influencing health workers' decisions to refer patients with cancer for physiotherapy rehabilitation in underdeveloped countries like Uganda. This study aimed to determine barriers and facilitators to the referral of patients with cancer for physiotherapy rehabilitation at UCI. 

Methods: A qualitative descriptive phenomenological design was adopted to conduct a case study at UCI. In-depth interviews were conducted on 12 UCI doctors and nurses who were selected using a convenience sampling from a population of 25. Thematic analysis was used to analyze the results. The UCI Research Ethical Committee granted ethical approval.

Results: Participants reported that facilitators to the referral of patients with cancer for physiotherapy rehabilitation included, but were not limited to; good communication between referring health workers and physiotherapists, patient clinical characteristics and previous positive outcomes of physiotherapy in management of patients with cancer. On the other hand, barriers included; inadequate knowledge on who should be referred for physiotherapy rehabilitation, fear of overworking the few physiotherapists, cancer complications that are perceived to be contraindicated for physiotherapy like intense pain

Conclusion: Doctors and nurses at UCI have experienced good outcomes and appreciate the benefits of physiotherapy management of patients with cancer. A limited knowledge on proper assessment of patients with cancer and deciding who to refer for physiotherapy and fear to overwhelm the few physiotherapists with a lot of patients limit referral of patients with cancer for physiotherapy rehabilitation at UCI.