Perspectives on physical therapy in advanced cancer care from those who give, receive, and refer: a qualitative interview study

Purpose Physical therapy (PT) can improve mobility, symptom relief, and quality of life (QoL) in advanced cancer, yet remains underused. Little is known about the barriers and facilitators influencing patients’ engagement in PT, physicians’ referral decisions, and physical therapists’ delivery of care. The aim is therefore to explore barriers and facilitators influencing the integration of PT in advanced cancer care, specifically shaping patient engagement, physician referral behavior, and physical therapists’ delivery of care. Methods Qualitative study using semi-structured, face-to-face interviews. Data were analyzed inductively using the Framework Method. Interviews were conducted in hospital, nursing home, and primary care settings in Brussels and Flanders, Belgium. Using purposive and snowball sampling, we included adults with advanced cancer, physicians (oncologists and General Practitioners (GPs)), and physical therapists. Results Thirty interviews (10 patients, 10 physicians, 10 physical therapists) identified barriers and facilitators shaping PT engagement, referral, and delivery. Patients’ engagement was influenced by symptoms, perceived benefits, coping style, social support, and awareness of PT’s role and reimbursement. Physicians’ referrals depended on knowledge of PT indications, local providers, procedures, and outcome expectations. Physical therapists’ delivery was shaped by oncology-specific knowledge, confidence, attitudes, and organizational support. Many factors operated at individual and environmental levels, with misalignment across the three groups limiting integration. Conclusion A combination of behavioral factors influences the integration of PT in advanced cancer care. This highlights the need for multilevel strategies targeting knowledge, roles, communication, and system structures to improve PT integration in advanced cancer care.