Barriers and facilitators for healthy lifestyle and recommendations for counseling in endometrial cancer follow-up care: a qualitative study

Abstract

Objectives

Lifestyle promotion during follow-up consultations may improve long-term health and quality of life in endometrial cancer patients. This study aimed to identify barriers and facilitators to improve and sustain a healthy lifestyle that can be translated to behavioral methods and strategies for lifestyle counseling.

Methods

Endometrial cancer patients from three hospitals were recruited to participate in a semi-structured interview. The data were transcribed and coded. Thematic analysis was applied to identify themes and the behavior change wheel was used as a theoretical framework. Data saturation was confirmed after 18 interviews.

Results

Barriers included knowledge gaps as well as lack of motivation and environmental opportunities to engage in health-promoting behavior. Facilitators included applying incremental lifestyle changes, social support, positive reinforcements, and the ability to overcome setbacks.

Conclusions

We propose the following intervention functions: education, persuasion, training, environmental restructuring, and enablement. Suitable behavior change techniques to deliver the intervention functions include information about the consequences of certain behavior, feedback on behavior, credible source, graded tasks, habit formation, restructuring of the environment, prompts/cues, goal setting, action planning, and social support. Including these recommendations in lifestyle counseling could aid lasting lifestyle change since it suits the needs and preferences of patients.

Keywords:

• Endometrial cancer
• lifestyle
• behavior change
• behavior change wheel
• follow-up care

Acknowledgements

All patient/personal identifiers have been removed or disguised so the patient(s) described are not identifiable and cannot be identified through the details of the story. The authors would like to thank everyone who participated in the interviews for their input. We would also like to thank Elly Kaats, from the Dutch Cancer Patient Organization for Endometrial Cancer “Olijf”, for her feedback during multiple stages of the project.

Consent form

All patients provided written informed consent.

Ethical approval

The study was exempt from review by the Medical Research Ethics Committee Brabant (NW2020-62) as this study is not subject to the Dutch Medical Research Involving Human Subject Act.

Author contributions

Conceptualization and methodology: all authors. Collection and assembly of data: Anne M. de Korte, Belle H. de Rooij, M. Caroline Vos, Dorry Boll, Ingrid van Loon and Nicole P. M. Ezendam. Data analysis and interpretation: Anne M. de Korte, Belle H. de Rooij, M. Caroline Vos and Nicole P. M. Ezendam. Writing – original draft: Anne M. de Korte, Belle H. de Rooij, M. Caroline Vos and Nicole P. M. Ezendam. Writing – review and editing: all authors. Accountable for all aspects of the work: all authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, AK. The data are not publicly available due to restrictions; data contain information that could compromise the privacy of research participants.

Additional information

Funding

This study was supported by a grant from Stichting Vrienden Integrale Oncologische Zorg (VIOZ).