Adoption
cancer, ill, ’
CANCER
Of the 111 people referred to TelePR only 57 (51%) attended at least one PR session. In comparison, only 28 (28%) of the 98 referred to SPR attended at least one PR session. Therefore, although adoption was low, a higher proportion of patients were willing to initiate TelePR than SPR. There were several barriers to community settings agreeing to have the TelePR sessions conducted from their sites which included concerns about equipment theft, climate control for storage, and safety concerns in case other people used the equipment. There were also liability concerns that needed to be addressed by our legal consultants.Our qualitative interviews revealed that one important barrier to TelePR adoption was related to beliefs that PR itself was not effective because patients’ clinicians had not previously recommended it. An illustrative quote is: “… Barriers to participation in any form of PR included having to prioritize treating more pressing health concerns such as cancer or dialysis appointments. Comorbidities prevented adoption due to scheduling conflict concerns with other clinic appointments, and concern about burden to family members who would be needed for transportation and for attending sessions. In fact, once a referral was made to either TelePR or SPR, the need to attend an in-person medical clearance exam was a common barrier to completing the referral. Social constraints included caring for grandchildren and the need to have someone in the home to help them start the video sessions for TelePR. Further, some patients did not have adequate space in the home to store the equipment or did not have a permanent residence but did not want to attend sessions in community centers due to lack of transportation or feeling too ill to leave the home.