'You've Given Me My Voice'-Enhancing Engagement in Exercise Oncology Research: A Patient and Public Involvement Approach to Co‑Designing a Pre‑Radiotherapy Exercise Programme With People Living With Lung Cancer.

backgroundEmerging evidence suggests exercise may improve radiotherapy efficacy by reducing treatment resistance caused by tumour hypoxia. However, recruitment to exercise oncology studies is low (median 38%), particularly for people with lung cancer. One strategy to address such engagement barriers is by collaborating through Patient and Public Involvement and Engagement (PPIE).

objectiveTo co-design an acceptable pre‑radiotherapy exercise programme for people living with lung cancer, incorporating the perspectives and experiences of those affected by the disease.

methodsA PhD researcher collaborated with people impacted by lung cancer and an expert advisory group in a series of meetings and workshops underpinned by the principles of experience-based co-design and Boyd's co-design approach. Workshops were recorded and transcribed verbatim and analysed using reflexive thematic analysis. Findings relating to programme design were deducted into Frequency, Intensity, Time and Type principles, whereas barriers and facilitators were deducted into the five domains of the Practical planning for Implementation and Scale-up guidelines.

resultsSeven attendees accepted workshop invitation, of which three had received a lung cancer diagnosis, and four were family members. Considering design, daily exercise was regarded acceptable for short duration treatment plans, with an optimal duration of 20 min. Exercise intensity must also be personalised and autoregulated. Furthermore, 15 barriers and 40 facilitators were identified, the most pertinent relating to physical activity coach conduct and research design. For example, supervised exercise and developing professional working relationships were considered essential.

conclusionsThis project shows how PPIE can effectively inform early research to improve acceptability and presents the first co‑designed pre‑radiotherapy exercise programme for lung cancer. PATIENT OR PUBLIC CONTRIBUTION: PPIE was integral for this project. People diagnosed with lung cancer, along with family members, participated in two co‑design workshops, contributing their perspectives and experiences to shape the development of a pre‑radiotherapy exercise programme. Patient advocates within the advisory group reviewed and refined workshop materials to ensure they were accessible, meaningful, and patient‑friendly. Finally, one co‑design attendee and a patient advocate from the advisory group assisted drafting this manuscript to ensure published findings authentically represent the workshop discussions and the lived experiences shared throughout the project.