Table 4.
Themes and subcodes about barriers and facilitators to health promotion counseling emerging from interviews with 12 oncologists.
| Example | n | |
|---|---|---|
| Patient Factors | ||
| Non-cancer issues makes lifestyle change lower priority (B) | “[I]f they have lots of comorbidities, because there are obese women who have very severe arthritis or very severe heart disease or whatever. If they’re sick from other reasons and they’re really obese it seems besides [sic] the point.” (ID 8) |
2 |
| Interested in lifestyle changes (F) | “for someone who’s had surgery and is being followed actively… they always ask, “What else can I do?” They ask about diet, they ask about vitamins” (ID 4) | 7 |
| Oncologist Factors | ||
| Primary concern is cancer care (B) | “[T]his may be tunnel vision… we’re so focused on the cancer that it’s like almost as if you made it this far, it should be a switch to now let’s maintain your longevity by augmenting the rest of your life, but it almost feels like ‘phew.’ ” (ID 5) | 12 |
| Lack of training on lifestyle change, evidence of its benefits (B) | “[Oncologists are] not necessarily maintaining their internal medicine boards and don’t feel necessarily comfortable that they’re keeping up with that literature and keeping up with what might be the state of the art.” (ID 1) |
8 |
| Fear of causing distress or overwhelming patient (B) |
“they’re stressed out about their scan results, bad lab results, we talked about a million and a half things, am I going to add weight loss to their issue? No.” (ID 10) |
4 |
| Perceives patient benefit to addressing healthy lifestyle (F) | “I see this as giving the patient some power of taking control over a situation that is out of their control.” (ID 6) | 9 |
| System-Related Factors | ||
| Billing/Time (B) | “[T]here is stress to produce, stress to generate revenue, see as many patients, increase access, increase billing, you can’t have half hour conversations with people about weight loss.” (ID 1) | 11 |
| Issue related to primary care (B) | “[I]t’s almost like primary care people in general [are] deferring to the oncologists… and I think part of it is, the bulk of it is, discomfort.” (ID 6) | 7 |
| Effective Integration between cancer care and lifestyle change resources (F) | “I think that if you are trying to care in a holistic way for say a breast cancer patient, it would be nice to have all the services very seamlessly integrated.” (ID 4) | 11 |
Abbreviation: B, Barrier, F, Facilitator