Physiotherapists prioritise compassionate and patient-centred care while navigating systemic constraints and ethical dilemmas in cancer rehabilitation: a mixed-methods study.

Question: How do physiotherapists address bioethical issues in cancer rehabilitation? What drives physiotherapists' clinical actions regarding non-disclosure, patient autonomy, risk-benefit balance and treatment withdrawal?

Design: A mixed-methods study with an explanatory sequential design.

Participants: 681 Italian registered physiotherapists recruited via the National Federation of Physiotherapists' Registers.

Intervention: An online survey assessed physiotherapists' ethical responses, followed by focus groups with participants whose survey responses aligned with key bioethical principles: beneficence/non-maleficence, self-determination, justice/equity, defensive prudence and compassionate care.

Outcome Measures: Quantitative data identified bioethical principles adherence patterns, while qualitative analysis explored the reasoning behind these ethical stances.

Results: Quantitative findings highlighted compassionate care as the most emphasised principle (29%), followed by self-determination (26%) and defensive prudence (23%). Beneficence/non-maleficence (16%) and justice and equity (6%) were less prioritised. Qualitative analysis identified five themes: functional recovery as dignity ('clinical good is the patient good'), patient autonomy ('patient knows better'), equity concerns ('everyone deserves care'), risk aversion ('it's better not to take risks') and the relational nature of care ('relationships can heal'). The mixed-methods integration showed how physiotherapists balance ethical ideals with systemic constraints, highlighting the importance of care equity, not underscored by the sole quantitative data.

Conclusion: Physiotherapists working in cancer rehabilitation prioritise compassionate and patient-centred care while facing systemic constraints, risks and professional responsibilities. This study offers a framework for future research internationally and on other healthcare professionals.