Table 7 Synthesis of the combined results

Document analyses

Integration of palliative rehabilitation in cancer is limited in official documents:

• Rehabilitation was mentioned in the context of palliative care in 12 out of 23 documents (48%).

• The concept of palliative rehabilitation in cancer appeared in one document (Denmark).

• Rehabilitation and palliative care have separate care pathways, but there is some overlap in terms of goals, timing, organization, and professional content.

• Allied health professionals and rehabilitation professionals are required in multidisciplinary teams to improve assessment of patients’ needs and access to rehabilitation in palliative care.

• Research on palliative rehabilitation of cancer patients is lacking.

Stakeholder interviews

Limited integration of palliative rehabilitation in cancer in clinical practice:

• There is a common understanding of the main components in the definition of palliative rehabilitation in cancer, but an unclear distinction between palliative rehabilitation and palliative care.

• High agreement that palliative rehabilitation in cancer interventions is based on multidimensional approaches tailored to the patient’s needs and goals to enhance /uphold quality of life.

• Access to palliative rehabilitation in cancer is described as a postcode lottery, with challenges related to funding, care pathways, and education.

Survey

Indicators of integration are present in clinical practice but limited for palliative rehabilitation in cancer:

• Nearly all respondents work in multidisciplinary teams (87%) and follow standardised care pathways (SCPs) (71%) in follow-up of cancer patients.

• Just over half of those following SCPs report that rehabilitation is a component of the applied standardized care pathways for cancer patients.

• 25% of respondents believe that palliative care and palliative cancer rehabilitation offer the same services.

• Nearly one fifth perceive that cancer rehabilitation is not appropriate towards the end of life, though 81% disagreed.

• Routine assessment for rehabilitation needs in incurable cancer patients was reported by less than half of the respondents (44%).

• Respondents rate continuity of care between healthcare levels relatively high with a score of 67 (0 = poorly to 100 = excellent).

Synthesis of all sub studies

The overall results highlight that integration of palliative rehabilitation in cancer remains limited within official documents and in clinical practice, despite the presence of some integration indicators. Palliative rehabilitation in cancer integration is primarily observed within specific organisations in secondary healthcare systems in Denmark and the UK. However, widespread adoption remains limited. Stakeholders recognize that effective palliative rehabilitation in cancer implementation should be multidimensional, and that interventions must align with individual patient needs and goals, emphasizing a holistic approach. An ambiguous distinction exists between palliative rehabilitation in cancer and existing palliative care. Insufficient funding, lack of palliative rehabilitation in cancer included in care pathways, and competence deficiencies among healthcare professionals represent barriers to integration of palliative rehabilitation in cancer into clinical practice.