Physical Activity in Hospice Care: A Social Ecological Perspective to Inform Policy and Practice

Area of Science:

• Palliative Care
• Rehabilitation Medicine
• Health Psychology

Background:

• Physical activity (PA) is recognized as a valuable rehabilitation strategy in hospice care for symptom management and enhancing quality of life.
• Current understanding of PA intervention design and delivery for hospice patients is limited, with a predominant focus on individual-level psychological models.
• A social-ecological framework is needed to explore multi-level factors influencing PA engagement in this population.

Purpose of the Study:

• To explore patient and health provider perspectives on factors influencing physical activity (PA) participation within hospice care.
• To identify key determinants of PA engagement across individual, interpersonal, environmental, community, and policy levels.

Main Methods:

• Qualitative study involving focus groups and semi-structured interviews with 27 patients and 5 health providers across 5 UK hospices.
• Thematic framework analysis was employed to analyze the collected data.

Main Results:

• Eight significant themes emerged, highlighting the importance of viewing PA as therapy and addressing apprehension about harm.
• Key factors included the benefits of group-based and supervised PA, the need for patient-centered approaches, and overcoming barriers like limited facilities and access.
• The study identified a lack of a strong PA culture and absence of supportive policy/guidance as critical barriers.

Conclusions:

• Hospice-based PA interventions should adopt a multi-level, social-ecological approach to effectively promote and sustain patient behavior change.
• Findings offer evidence-based recommendations for designing and implementing successful PA programs within hospice settings.
• Addressing individual, social, environmental, and policy factors is crucial for optimizing PA participation in palliative care.