Perspectives about healthy eating and exercise among patients and providers at the safety-net Lyndon B. Johnson (LBJ) hospital oncology clinic.

Abstract

e24055 Background: Previous studies have described barriers and facilitators of healthy eating and exercise among cancer patients, but none have done so in a primarily low-income minority population. Understanding the perspectives of patients and providers from safety net hospitals has important implications for optimizing diet and exercise counseling and referral strategies to bridge disparities in cancer care and outcomes. Methods: The population at LBJ hospital is majority Hispanic and Black that are uninsured or underinsured. We conducted semi-structured interviews with patients who were either undergoing or completed cancer treatment at LBJ, as well as with clinic providers, to compare perceived barriers and facilitators of healthy eating and exercise. Interviews were audio-recorded, transcribed, and analyzed via hybrid analysis. Results: Thirty-one patients were interviewed, including 20 (65%) survivors and 11 (35%) who were on active treatment. Twenty-one (68%) were female, 22 (71%) Black, 5 (16%) Hispanic, and 4 (13%) other. Twenty-one healthcare providers were interviewed, including 5 (24%) physicians, 5 (24%) nursing professionals, 4 (19%) dietitians, and 7 (33%) ancillary staff. Barriers to healthy diet and exercise for patients as perceived by providers included lack of knowledge (100%), low access (80%) due to financial difficulties, transportation issues, work and family responsibilities, and low motivation (76%). This resulted in reluctance to counsel patients about healthy living, in part due to anticipated low adherence to recommendations (33%). Most patients could name components of and thought they had a healthy diet (65%), but did not exercise enough (75%) due to cancer-related physical and mental health symptoms (68%). Patients recognized benefits of healthy eating and exercise during and after cancer treatment (32% each) and recalled recommendations from providers about healthy living (48%). Patients voiced high motivation to participate in healthy eating and exercise programming (84%) and follow their medical team’s recommendations (84%), so long as programming was convenient (29%) and included flexibility of multiple options (56%). Patients acknowledged resource-related barriers to healthy living but cited proximity to grocery stores and exercise facilities (84%), help from family in cooking meals (52%), and ability to walk outside or exercise with friends (13%). Conclusions: Despite multiple barriers of capacity, opportunity, and motivation to healthy eating and exercise, cancer patients in a safety-net hospital recognized the importance of healthy living, wanted to participate in such programs, and to get additional information or referrals from their medical team. Based on these results, ongoing studies are evaluating the implementation of referral pathways to healthy living programs for cancer patients at LBJ.