Co-design is a participatory research method that includes meaningful involvement of key research users and stakeholders in all stages of research. The aim of this work was to engage with those with a lived experience of cancer, their carers, oncologists, radiographers, physiotherapists and others potentially involved in intervention delivery to ensure an intervention was developed that men with prostate cancer would be able to engage in, and that could fit within the current prostate cancer patient pathway.
We conducted a series of co-design workshops to gauge stakeholder perceptions of the intervention, the acceptability and feasibility of intervention timing (immediately prior to each treatment session), identifying any potential barriers and facilitators, with the overarching aim of intervention refinement. This involved workshops with men with a lived experience of prostate cancer, carers and health care professionals.
Three iterative workshops involved 8 men with prostate cancer and carers, 2 radiographers and 2 oncologists. Workshops were recorded, transcribed verbatim and thematically analysed. Findings from workshop 1 were presented at workshop 2 and integrated findings at workshop 3.
There was widespread support for the proposed intervention, with exercise recognised as an important part of treatment and recovery. Both generic and prostate-specific barriers were suggested. Generic concerns included: participant motivation and recruitment; managing cancer symptoms; exercise timing and location; a time course of the benefits; exercise boredom. Prostate-specific concerns focused on: pre-radiotherapy bladder filling and exercise, pain and discomfort; suitable surrogate endpoints; scheduling; securing necessary support (e.g. physiotherapists / radiographers); simulation scans replicating treatment conditions; and future proofing against radiotherapy refinements (e.g. stereotactic).
Although barriers were articulated, solutions were suggested. It was proposed that aerobic exercise (e.g. treadmill or brisk walking) would be appropriate for men with prostate cancer, as would an exercise ‘buddy’ to manage monotony. Integrating exercise with water intake may serve as a welcome distraction during bladder filling. Finally, personalisation to each individual was a key recommendation alongside support from treating oncologists.
The introduction of exercise immediately prior to radiotherapy for men with prostate cancer is challenging. Prior to embarking on a clinical trial to test effectiveness we wanted to ensure we created an intervention that could be successfully implemented in practice, and also enhance trial success by optimising recruitment, adherence and retention rates. The next stage in the process is feasibility testing of the co-designed intervention.
oncology
exercise
