Risk reduction for side effects after breast cancer treatments - A pilot qualitative study of physical therapists’ perception of strengths and weaknesses of Israeli health services

Tamar Jacob1, Jillian Bracha2

1Prof. Jacob, PhD, MPH, PT, is the head of Masters’ program in Physical Therapy, Physical Therapy Department, Ariel University, Israel
2Ms Jillian Bracha, MScPT. Casley Smith Clinical Instructor. Lymphedema Therapist, Private Practice, Maagan Michael, Israel


Introduction: Side effects after breast cancer treatments are related not only to physical discomfort, but also to reduced quality of life, stress, and anxiety among patients. Despite a high prevalence of secondary complications, guidelines for risk reduction do not exist.
Aims: To learn from physical therapists’ clinical experience and perception about: 1. Strengths and weaknesses of Israeli Health Services in risk reduction for side effects after breast cancer treatments. 2. Recommendations for improvement.

Methods: This study is part of a large qualitative study. Study population includes 10 senior physical therapists, certified in lymphedema treatment with over 7 years of clinical experience. Data were collected by telephone interviews. The interview included the following open-ended questions: 1. What, in your opinion, are the current strengths and weaknesses of the Health Services in terms of efforts to reduce the risk of side effects in women after breast cancer treatments? 2. What steps would you recommend that existing rehabilitation programs take to better address risk reduction in this population?

One researcher conducted all of the interviews, in order to maintain uniformity. Once interviews were completed, a thematic analysis was performed on the answers, which were categorized according to content.

Results: Thematic analysis of participants’ responses regarding the degree to which health services address risk reduction in the relevant population revealed three categories of strength and three of weakness. Participants had opposing views on the same issue. The strengths were accessibility of health care services; efforts to increase medical staffs’ awareness about common side effects; and strong education and professional development for physiotherapists. The following weaknesses emerged as themes: insufficient accessibility of services; insufficient knowledge; and poor quality of interventions that fail to incorporate risk reduction. Recommendations for improvement included the need to identify women who are at high risk for side effects so as to guide them on proper care measures, the need to schedule their first physiotherapy session with a lymphatic care expert, and the need to create professional guidelines for interventions that target risk reduction for this population

Conclusions: All of the interviewees identified weaknesses in the health services offered in Israel to regarding efforts to reduce the risk of side effects in women who undergo treatment for breast cancer. There was a lack of agreement among the interviewees regarding strengths and weaknesses of the health system. This study raises the need to develop standardized guidelines for interventions that aim to reduce the risk of side effects in the relevant population.

Key words: Breast cancer, side effects, risk, physical therapy

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