br Methods br To gain
To gain an in-depth understanding of older cancer patients' ex-periences and attitudes towards PA, the study adopted a qualitative approach using semi-structured interviews. In addition, quantitative data regarding the informants’ demographics, medical history and PA level will be collected to increase transferability of the study.
2.2. Participants and procedures
Eligible participants were patients ≥ 65 years with advanced pan-creatic, biliary tract or non-small cell lung cancer (NSCLC) who cur-rently received first-line palliative chemotherapy or immunotherapy at the outpatient clinic at the Department of Oncology, Herlev and Gentofte Hospital, Denmark, from November 2017 to March 2018. The decision to include patients with biliary tract, pancreatic and NSCLC was based on the fact that Rosiglitazone these cancers are most often diagnosed among older people (median age at diagnosis 67–72 years), and be-cause the majority of these patients already have advanced disease at the time of diagnosis (Ansari et al., 2016; Valle et al., 2010; Walters et al., 2013). The only exclusion criterion was if patients were unable to provide an informed consent due to cognitive or linguistic challenges. A purposeful sampling strategy was used to ensure variation in diagnosis, gender and age. Eligible patients were approached and informed about the study by the primary investigator Marta Kramer Mikkelsen (MKM).
2.3. Data collection
A semi-structured interview guide that focused on two diﬀerent research topics was developed. The selected research topics were (a) experiences and coping with cancer, treatment-related symptoms and side eﬀects, and (b) experiences with and attitudes towards PA and exercise during cancer treatment. This current article solely covers the results from research topic b. The guide included an introductory question about the patients' current PA level, and then comprised questions related to three research areas; (I) attitudes towards PA, (II) barriers towards PA, and (III) motivators, facilitators and preferences for PA (Table 1). Interviews were conducted by MKM at the hospital, by telephone or in the informant's home according to the informant's preference. If an informant preferred that a relative was present during the interview, Membrane proteins was accepted. All interviews were digitally recorded and transcribed verbatim. Patient-reported data on socioeconomics were collected through a questionnaire. Current leisure time PA was
assessed with a modified version of the Saltin-Grimby Physical Activity Level Scale (Schnohr et al., 2003). In this questionnaire, leisure time PA is assessed on a scale from I to IV following the categories: I = mostly sedentary (engaging in light PA < 2 hours per week), II = light PA for 2–4 h per week, III = light PA > 4 h per week or more vigorous activity for 2–4 h per week, and IV = highly vigorous PA > 4 h per week or regular heavy exercise or competitive sports several times a week (Schnohr et al., 2003). Data on comorbidities, diagnosis, oncological treatment, and Eastern Cooperative Oncology Groups (ECOG) perfor-mance status (PS) were collected from medical charts. Comorbidities were assessed according to the Charlson Comorbidity Index (CCI) (Charlson et al., 1987).
The study was reported to the Scientific Ethics Review Committee of the Capital Region of Denmark (J.nr.:H17027105) and to the Danish Data Protection Agency (j.nr.:2012-58-0004), and was conducted in accordance with the Helsinki Declaration (World Medical Association, 2013). Consent for study participation was obtained before each in-terview.
As the informants for this study can be considered as a highly vul-nerable group of patients (older patients with advanced cancer during oncological treatment), eﬀort was made to ensure that participation in the study was as easy and convenient for the informants as possible. Therefore, interviews at the hospital were all conducted when the in-formants were already at the hospital for a scheduled appointment. By preference, the informants were also allowed to have a relative present during the interview to ensure that all informants felt as comfortable during the interviews as possible.
All qualitative data were managed with the QSR International's NVivo 12 software and analyzed using the 6-step thematic analysis described by Braun and Clark (Braun and Clarke, 2006); (I) reading the transcripts or listening to the recording several times, (II) generation of meaningful units, (III) searching for themes, (IV) reviewing themes and deciding which to combine, refine or separate, (V) defining and naming themes, and (VI) writing the report. The full analysis was conducted by MKM, and in triangulation with Mary Jarden (MJ) in steps III-V.