Understanding the Importance of Therapeutic Relationships in the Development of Self-Management Behaviours After Cancer Rehabilitation: A Qualitative Mixed-Methods Study

Abstract

This Professional Practice Doctorate research explored the importance and impact of therapeutic relationships in the development of sustainable self-management behaviours during cancer rehabilitation. This research aimed to evidence the need to preserve person-centred cancer rehabilitation. It aimed to protect local services from organisational pressures to rationalise rehabilitation through standardised, protocol driven practice. Therapeutic relationships are an important aspect of multi-disciplinary healthcare practice. However, they receive inversely proportionate attention in the research literature. Where research exists, it has often focused on elements of the relationship, rather the entire relationship. This is likely reflective of the complexity of therapeutic relationships. This research was undertaken in three phases alongside clinical practice. An integrative literature review was completed in parallel to semi-structured interviews, and a Modified Delphi Technique. The results confirmed the underlying assumption that the local cancer rehabilitation service was effective in supporting the development of self-management behaviours. Participants perceived professionals’ characteristics and behaviours to be a significant barrier or enabler to the development of therapeutic relationships. Therapeutic relationships were found to have significant roles or functions at different stages of cancer rehabilitation. On completion of cancer rehabilitation, the dissolution of therapeutic relationships was not consistently well managed by professionals, resulting in residual dependency or alienation. Poor participant experiences of previous therapeutic relationships may explain poor early engagement in rehabilitation, protracted rehabilitation duration and poor self-management outcomes. These findings provide insight for decision-making around cancer rehabilitation service design and workforce skills development. This research sets the foundation for future studies to measure the impact of therapeutic relationships on self-management outcomes. These insights could also inform the design and evaluation of learning opportunities for professionals, optimising the management of therapeutic relationships. Future research would focus on how to support professionals to meet the long-term needs of people affected by cancer and other LTCs.