A qualitative evidence synthesis of participant, caregiver, and provider experiences of lung cancer exercise programs

Purpose: This review sought to synthesise the existing qualitative literature to answer the question: “What are the experiences of people with lung cancer, caregivers, and/or providers regarding participation in or delivery of exercise programs?”. Methods: A qualitative evidence synthesis. Published literature from databases EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), Cochrane Library, Scopus, PEDro, and Web of Science and grey literature using thesis repositories and Google Scholar were searched on 18th February 2022 and updated on 8th October 2024. Included studies’ methodological limitations were evaluated using the Critical Appraisal Skills Programme (CASP) checklist by two independent researchers. First- and second-order qualitative data were extracted, cross-checked, and combined in thematic synthesis by one researcher, with another coding 10%, and they collaborated to determine the final themes, subthemes, and findings. Two independent researchers assessed the confidence in the findings using the GRADE-CERqual approach. Results: Twenty-four studies were included comprising 23 unique exercise programs (10 supervised centre-based and 13 unsupervised, home-based programs.). All studies included patients’/participants’ perspectives; six included clinicians, and two included caregivers. Forty-one findings were organised under four broad themes: 1) components of exercise program design, 2) providers of exercise programs, 3) the value of exercise programs, and 4) facilitating behaviour change. Overall, key stakeholders viewed exercise programs as effective and acceptable and valued individualised and tailored programs. Most findings were of moderate-to-high confidence. Conclusion: Based on the experiences of key stakeholders, 15 specific recommendations were generated that may improve the acceptability and effectiveness of lung cancer exercise programs.