Behavior Change, Psychosocial Support, and Interprofessional Collaboration
Adherence is a skill
Most survivors do not meet activity guidelines; adherence depends on behavior-change competence, not program elegance. Know the transtheoretical model (precontemplation through maintenance), self-efficacy, social cognitive theory, and self-determination theory (autonomy, competence, relatedness). Motivational interviewing - open questions, affirmations, reflections, summaries - outperforms advice-giving when ambivalence is present. Build specific, proximal, measurable goals; implementation intentions ("I will walk after lunch on Monday, Wednesday, and Friday"); self-monitoring; and a written relapse plan.
Psychosocial factors
Fear of recurrence, body image concerns, fatigue, anxiety, depression, cancer-related distress, and social isolation all influence participation. Screen with a validated distress measure or a few direct questions, then refer. Do not attempt psychotherapy outside your scope.
The team
Oncology, nursing, physical therapy, occupational therapy, dietetics, psycho-oncology, social work, lymphedema therapy, and cardiology. Communication should be closed-loop: state the finding, make a specific request, name a timeframe. Document both the referral and the response.
Traps
Confrontational or fear-based persuasion; goals the client never chose; progressing upper-body loading without coordinating with the lymphedema therapist; treating distress screening as a formality.
Worked example
A client says, "I know I should exercise but I'm scared it will bring the cancer back." Reflect and validate the fear, offer accurate reassurance that exercise is safe and associated with better outcomes, then negotiate one small, low-risk first step.
Rule of thumb
The best program is the one the client will actually do next week; build adherence before building volume.