Proposing the use of a physiotherapist navigator in an acute cancer care setting in Ontario: A nationwide survey using a modified Delphi approach.

Abstract

To engage health care providers in Canada to identify the roles, tasks, processes, assessments, and triaging decisions for a Physiotherapist (PT) Navigator role that will be implemented and evaluated in a future trial. A two-round, online, modified reactive Delphi study was used. Any licensed health care practitioner in Canada who works with individuals with or beyond cancer was eligible to participate. Round 1 identified qualitative feedback on role domains to guide role improvement. Qualitative feedback was examined in duplicate using content analysis. Round 2 identified quantitative feedback to gather numerical data to establish consensus. Quantitative survey feedback was analysed using descriptive statistics including mean and standard deviation. Items were added to the role description if identified by ≥10% of respondents, and 75% was the threshold to define consensus. Lastly, a consensus meeting including end users was held to consider priority items and utility of role translation into clinical practice. Consensus on the PT Navigator role description was achieved following the two survey rounds (Round One; n = 34, Round Two; n = 18). Four domains were identified to define the role: process, assessment, triaging decisions, and duties and responsibilities. A figure visualizing the PT Navigator role was generated. Changes to the role after survey feedback included increasing appointment times with the PT Navigator, longer duration between follow-ups, patient self-referral, and additional objective testing. Consensus meeting feedback considered the variability in follow-up depending on different treatment timelines and an emphasis on promoting self-management strategies. Perceived usefulness of the role was high (mean 9.19/10; SD 2.12). This modified Delphi study identified key domains that would inform development of a comprehensive PT Navigator role working with cancer patients. The role offers a novel approach to promote routine assessment and early intervention, with the aim towards integrating PTs meaningfully within cancer care settings in Canada.