Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study

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Despite strong evidence and policy support, integration of exercise into routine cancer care in Ireland remains limited. The PERCS (Personalised Exercise Rehabilitation in Cancer Survivorship) triage and referral system was developed to provide a structured, stepped-care model directing patients to the appropriate level of exercise support. Following on from a feasibility study, this protocol describes a qualitative study to inform national implementation. Methods This multi-stakeholder study will use focus groups and interviews with four stakeholder groups: 1) Healthcare professionals, 2) Exercise professionals, 3) Policymakers, charity partners, and cancer centre managers, and 4) People living with and beyond cancer, carers and family members. Topic guides, informed by the Consolidated Framework for Implementation Research (CFIR) and tailored to each stakeholder group, will seek to explore barriers, facilitators, and contextual factors that influence implementation. Data will be analysed using framework analysis. Transcripts will be coded using both a CFIR-based deductive coding approach and inductive codes that are relevant to the research aim, and key points will be organised to allow comparison of responses across participant groups. The findings stemming from this work will inform the selection of tailored implementation strategies mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Conclusion This study will generate detailed, context-sensitive evidence on the barriers and facilitators to implementing the PERCS system at a national level. By engaging with key stakeholders and using a structured implementation science approach, the findings will guide the development of practical, policy-relevant strategies to support the integration of exercise rehabilitation into survivorship care. The study will contribute to ongoing efforts to improve quality of life for cancer survivors in Ireland and build capacity for sustainable, person-centred cancer rehabilitation services." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://hrbopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://hrbopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://hrbopenresearch.org/articles/8-115/v2", "name": "Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship..." } } ] } Home Browse Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Tierney M, Sheill G, Toomey E et al. Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.12688/hrbopenres.14272.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Revised Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] Marie Tierney https://orcid.org/0000-0002-2428-0188 1,2 , Gráinne Sheill 1,3 , Elaine Toomey 4,5 , [...] Dearbhaile O'Hare 6 , Tom Conway 4,6 , Louise Mullen https://orcid.org/0000-0003-0079-2469 7 , Claire L Donohoe 1,8 , Emer Guinan 1,2 Marie Tierney https://orcid.org/0000-0002-2428-0188 1,2 , Gráinne Sheill 1,3 , [...] Elaine Toomey 4,5 , Dearbhaile O'Hare 6 , Tom Conway 4,6 , Louise Mullen https://orcid.org/0000-0003-0079-2469 7 , Claire L Donohoe 1,8 , Emer Guinan 1,2 PUBLISHED 10 Mar 2026 Author details Author details 1 Trinity St James's Cancer Institute, Dublin, Ireland 2 Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland 3 Department of Physiotherapy, St James's Hospital, Dublin, Ireland 4 Centre for Health Research Methodology, School of Nursing & Midwifery, University of Galway, Galway, Ireland 5 Institute for Clinical Trials, College of Medicine, Nursing & Health Sciences, University of Galway, Galway, Ireland 6 Independent Public and Patient Involvement Contributor, Ireland, Ireland 7 National Cancer Control Programme, Health Service Executive, Dublin, Ireland 8 Department of Surgery, St James's Hospital, Dublin, Ireland Marie Tierney Roles: Conceptualization, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Gráinne Sheill Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Elaine Toomey Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Dearbhaile O'Hare Roles: Methodology, Writing – Review & Editing Tom Conway Roles: Methodology, Writing – Review & Editing Louise Mullen Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Claire L Donohoe Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Emer Guinan Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Exercise rehabilitation offers substantial benefits for people living with and beyond cancer, improving physical, psychological, and disease-related outcomes. Despite strong evidence and policy support, integration of exercise into routine cancer care in Ireland remains limited. The PERCS (Personalised Exercise Rehabilitation in Cancer Survivorship) triage and referral system was developed to provide a structured, stepped-care model directing patients to the appropriate level of exercise support. Following on from a feasibility study, this protocol describes a qualitative study to inform national implementation. Methods This multi-stakeholder study will use focus groups and interviews with four stakeholder groups: 1) Healthcare professionals, 2) Exercise professionals, 3) Policymakers, charity partners, and cancer centre managers, and 4) People living with and beyond cancer, carers and family members. Topic guides, informed by the Consolidated Framework for Implementation Research (CFIR) and tailored to each stakeholder group, will seek to explore barriers, facilitators, and contextual factors that influence implementation. Data will be analysed using framework analysis. Transcripts will be coded using both a CFIR-based deductive coding approach and inductive codes that are relevant to the research aim, and key points will be organised to allow comparison of responses across participant groups. The findings stemming from this work will inform the selection of tailored implementation strategies mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Conclusion This study will generate detailed, context-sensitive evidence on the barriers and facilitators to implementing the PERCS system at a national level. By engaging with key stakeholders and using a structured implementation science approach, the findings will guide the development of practical, policy-relevant strategies to support the integration of exercise rehabilitation into survivorship care. The study will contribute to ongoing efforts to improve quality of life for cancer survivors in Ireland and build capacity for sustainable, person-centred cancer rehabilitation services. READ ALL READ LESS Keywords Exercise rehabilitation, Cancer survivorship, PERCS, National implementation, Barriers and facilitators, Qualitative study Corresponding Author(s) Marie Tierney ( [email protected] ) Close Corresponding author: Marie Tierney Competing interests: No competing interests were disclosed. Grant information: This research was funded by the Health Research Board Ireland [ILP-HSR-2024-011]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2026 Tierney M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Tierney M, Sheill G, Toomey E et al. Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.12688/hrbopenres.14272.2 ) First published: 27 Oct 2025, 8 :115 ( https://doi.org/10.12688/hrbopenres.14272.1 ) Latest published: 10 Mar 2026, 8 :115 ( https://doi.org/10.12688/hrbopenres.14272.2 ) Revised Amendments from Version 1 This revised version incorporates reviewer feedback. The Introduction has been updated to clarify the contribution of exercise to quality of life outcomes. Additional detail has been added regarding PERCS 1.0 triage pathways, including Level 1-3 descriptions and referral proportions. The Methods section now defines Public and Patient Involvement (PPI) at first mention. No changes were made to study design or conclusions. This revised version incorporates reviewer feedback. The Introduction has been updated to clarify the contribution of exercise to quality of life outcomes. Additional detail has been added regarding PERCS 1.0 triage pathways, including Level 1-3 descriptions and referral proportions. The Methods section now defines Public and Patient Involvement (PPI) at first mention. No changes were made to study design or conclusions. To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. READ REVIEWER RESPONSES Introduction Over 200,000 people in Ireland are currently living with and beyond cancer, and this number is projected to rise significantly as 10-year survival rates continue to improve, in line with European estimates ( Lawler et al. , 2023 ). With survivorship increasing, there is growing recognition of the importance of addressing the longer-term health and quality-of-life needs of this population. The National Cancer Strategy 2017–2026 ( Department of Health, 2017 ) explicitly commits to enhancing quality of life for survivors, recognising exercise rehabilitation as a key component of survivorship care. Cancer treatment can result in a range of physical and psychosocial sequelae, including fatigue, muscle weakness, reduced cardiopulmonary fitness, anxiety, and depression, many of which are amenable to targeted exercise interventions ( Campbell et al. , 2019 ; Courneya et al. , 2025 ). An estimated 60–90% of individuals affected by cancer have at least one specialised rehabilitation need ( Pergolotti et al. , 2015 ), which may include cancer-related comorbidities or impairments such as weakness, cachexia, loss of balance, lymphoedema, or pain. There is robust international evidence supporting the role of exercise in improving physical, psychological, and disease-related outcomes, including fatigue, functional capacity, and health-related quality of life, for people living with and beyond cancer but it is important that exercise support is adaptable to individual needs. Patients with significant impairments may benefit from hospital- or primary-care-based rehabilitation programmes delivered by rehabilitation specialists, while physically inactive patients without impairments may be well served by community-based exercise programmes delivered by physiotherapists or exercise specialists ( Coletta et al. , 2020 ; Schmitz et al. , 2021 ). To allow translation of exercise guidelines into practice, coordinated systems are needed to direct patients to the appropriate level of care, balancing clinical need with service capacity. This typically involves collaborative models that span hospital and community settings. Internationally, stepped-care approaches and triage and referral systems have been proposed to guide decision-making and streamline access to appropriate supports ( Capozzi et al. , 2023 ; Covington et al. , 2021 ; Dennett et al. , 2020 ; Mina et al. , 2018 ; Schmitz et al. , 2024 ; Stout et al. , 2020 ). These models generally recognise a spectrum of complexity arising from comorbidities and treatment side-effects, incorporate screening assessments to identify risks requiring medical or rehabilitation oversight and recommend tailored referrals to supervised rehabilitation, community exercise programmes, or self-management supports. While some of these frameworks are underpinned by formal triage processes ( Capozzi et al. , 2023 ; Covington et al. , 2021 ; Stout et al. , 2020 ), most remain theoretical. Only a limited number have been tested for feasibility and implementation in real-world settings, demonstrating positive outcomes ( Capozzi et al. , 2023 ; Schmitz et al. , 2024 ). These models also typically operate within health systems such as those in the United States, Canada, and Australia where access to cancer physiatry, clinical exercise physiologists, and tiered rehabilitation services are well established. In contrast, the vision of every cancer patient in Ireland having access to exercise during and after treatment is not yet being realised. Survivors often face multiple barriers to engagement, including a lack of professional guidance, unclear referral pathways, and limited local service availability ( Brennan et al. , 2022 ; Nadler et al. , 2017 ; Riordan et al. , 2025 ). Ireland does not currently have a recognised cancer physiatry discipline, and clinical exercise physiologists are not formally integrated into the healthcare system. Rehabilitation services remain unevenly distributed and poorly resourced, contributing to inconsistent access to appropriate support. To address this gap, the research team developed the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) system, a triage and referral model tailored to the Irish healthcare context. The system assesses cancer survivors’ exercise needs and guides referral to one of three appropriate pathways: (1) independent exercise with provision of online resources, (2) community-based exercise programmes, or (3) physiotherapist-led rehabilitation. PERCS 1.0, funded by the Irish Cancer Society, tested the feasibility and acceptability of this system through a physiotherapy-led clinic for survivors of cancer treated during the COVID-19 pandemic. Results were highly encouraging and demonstrated the feasibility of a structured triage pathway to support exercise participation across differing levels of need: • Over 90% of participants required support to become physically active ( Brennan et al. , 2024 ). • Triage referred 9.4% of participants to Level 1 , where advice and encouragement were provided to support independent physical activity and self-management. The majority (67.2%) were referred to Level 2 community-based supervised exercise programmes, delivered either in person or online according to individual needs and preferences. A further 23.4% were allocated to Level 3 , involving referral to physiotherapy-led rehabilitation services to address more complex rehabilitation needs ( Brennan et al. , 2024 ). • Adherence to physical activity guidelines improved for both aerobic and resistance exercise at 12 weeks ( Brennan et al. , 2024 ). • Participants reported high satisfaction with the personalised assessment and referral approach ( Brennan et al. , 2025 ). These findings provided critical proof-of-concept for the PERCS triage and referral approach, demonstrating real-world feasibility and positive patient impact within the Irish setting. PERCS 2.0 seeks to build on this work by shifting the focus from local feasibility to national implementation through the exploration of and response to the contextual factors influencing the scaling of the PERCS system across the Irish healthcare landscape. Aims and objectives The aim of this study is to inform the national implementation of the PERCS triage and referral system by understanding key contextual factors influencing its uptake and identifying strategies to support its successful delivery across the Irish healthcare system. To achieve this aim, the objectives are: • To explore the contextual factors influencing the implementation of the PERCS triage and referral system nationally and. • To identify and prioritise the implementation strategies that can address these contextual factors. These aims will be achieved using the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis and the Expert Recommendations for Implementing Change (ERIC) taxonomy to map factors to potential strategies. Methods Study design This study will utilise a qualitative methodology, collecting data through focus groups and individual interviews. Both formats will follow the same semi-structured topic guide and the choice of formats is offered to ensure flexibility and accessibility for participants. Focus groups will be used where appropriate to explore shared perspectives and group dynamics, while interviews will be conducted with individuals who prefer or require a one-on-one format (e.g. due to time constraints, or geographic location). The use of both formats is not intended to produce different types of responses, but rather to maximise inclusivity and engagement across a diverse range of stakeholder groups. Sample selection and recruitment A purposive sampling strategy will be used to ensure maximum variation across roles, geography, and healthcare settings. Four stakeholder groups will be recruited: 1. Healthcare professionals involved in cancer care (e.g. oncology nurses, consultants, physiotherapists). 2. Exercise professionals. 3. Policymakers, charity partners, and cancer centre managers. 4. People living with and beyond cancer, carers, and family members. Inclusion criteria include adults aged 18 or older with direct experience relevant to one of the stakeholder groups. Participants must be able to provide informed consent and take part in English. Participants will be identified through project partner organisations, clinical contacts, patient networks, and the research team’s stakeholder database. Potential participants will be informed about the study through a recruitment letter/poster/social media post outlining essential information about the study. Individuals interested in learning more about the study will be encouraged to contact the lead investigator directly to receive further information via a participant information leaflet (Appendix 1), ask questions, and discuss any aspect before deciding whether to participate. Sample size We anticipate recruiting approximately 50 participants across stakeholder groups, though the final number may vary. This sample was chosen to ensure sufficient diversity across participant groups and to enable comprehensive charting with the Framework Analysis approach. Intervention context and analytical approach The intervention under study is the PERCS triage and referral system, which comprises three stages: 1. Patient Assessment 2. Triage 3. Creation of a personalised exercise plan Participants will receive a brief description and/or infographic of the PERCS model before or at the start of the session to support shared understanding. Data collection and analysis will be guided by CFIR to identify key contextual factors influencing national implementation of the PERCS system. Findings will also inform the development of relevant, stakeholder-informed implementation strategies, mapped to the ERIC taxonomy. Data collection and analysis All data collection will be conducted by an experienced qualitative researcher trained in implementation science. Data will be collected via focus groups and individual interviews using semi-structured topic guides tailored to four stakeholder groups: healthcare professionals, exercise professionals, policymakers/cancer centre managers/charity representatives, and people living with and beyond cancer, carers and family members. The topic guides (Appendix 2) were developed collaboratively by the research team using CFIR to highlight relevant domains and constructs for exploring contextual influences on the implementation of the PERCS triage and referral system. Development was also informed by findings from the PERCS 1.0 feasibility study and input from both the research team and Public and Patient Involvement (PPI) panel. Initially draft guides were created and tailored to each stakeholder group but maintained a common structure to ensure comparability. They were reviewed by experts in implementation science, clinical stakeholders, and PPI contributors, and refined though an iterative process until agreement was reached. Each guide includes prompts on awareness of the PERCS model, anticipated barriers and enablers, relevance to local context, and support needs for embedding the model in routine care. All interviews and focus groups will be audio-recorded, transcribed verbatim, and pseudonymised. Transcripts will be analysed using framework analysis, an approach suited to applied research using structured conceptual frameworks like CFIR. Analysis will proceed through the following steps: • Familiarisation: The researcher will read and re-read transcripts to immerse themselves in the data. • Coding: A coding framework will be developed based on CFIR constructs, supplemented by inductive codes that emerge during analysis. This hybrid approach allows for both theoretical alignment and responsiveness to stakeholder perspectives. One researcher will code the transcripts, with another independently reviewing a sample of the transcripts to support rigour. There will also be regular team discussions to support reflexivity, enhance consistency, and ensure that interpretations remain grounded in the data. • Indexing: The framework will be applied systematically across transcripts. • Charting: Key data will be summarised in a matrix by code and participant group to enable comparison across settings, roles, and perspectives. • Mapping and interpretation: Emerging patterns will be interpreted within and across CFIR domains to identify key contextual influences on implementation. Findings will be used to inform a set of prioritised implementation strategies, mapped to the ERIC taxonomy. All data management and analysis will be supported using NVivo software. Ethical considerations Ethical approval has been obtained from the TCD School of Medicine Research Ethics Committee (approval number: 250606). All participants will receive a detailed Participant Information Leaflet and provide written informed consent prior to participation. Data will be pseudonymised and stored securely on encrypted university servers, in compliance with GDPR and HRB data governance policies. Transcripts will be anonymised, and any direct identifiers removed before analysis. Dissemination plan • Findings from this study will be disseminated through: • Peer-reviewed journal articles and national/international conference presentations • Stakeholder workshops and briefing documents tailored to HSE, cancer centres, and community partners • Lay summaries for participants and the broader cancer survivor community All outputs will align with HRB Open Research policies for transparency, accessibility, and research integrity. Conclusion This study aims to generate in-depth, contextually relevant information which can feed into the implementation of the PERCS triage and referral system for exercise rehabilitation in cancer survivorship across Ireland. By engaging with a broad range of stakeholders and applying the CFIR framework within a rigorous qualitative methodology, the research will identify key barriers, facilitators, and contextual considerations that influence implementation. These findings will inform the development of targeted, stakeholder-informed strategies to support the national scale-up of PERCS and contribute to broader efforts to integrate exercise into routine cancer care. The study will provide a valuable platform for future implementation planning, policy development, and service design of cancer rehabilitation. Data availability Underlying data No data are associated with this article. Extended data Open Science Framework. Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study: 10.17605/OSF.IO/RDJYV Extended data in this project pertain to: Appendix 1: Participant Information leaflets Appendix 2: Topic guides for interviews and focus groups Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References Brennan L, Kennedy M, Grehan S, et al. : Patient experiences of participating in a cancer rehabilitation triage and referral system in the Irish healthcare system. J Cancer Surviv. 2025: 40146479. Publisher Full Text Brennan L, Sheill G, Collier S, et al. : Personalised exercise rehabilitation in cancer survivorship: findings from a triage and referral feasibility study. J Cancer Surviv. 2024. PubMed Abstract | Publisher Full Text Brennan L, Sheill G, O’Neill L, et al. : Physical therapists in oncology settings: experiences in delivering cancer rehabilitation services, barriers to care, and service development needs. Phys Ther. 2022; 102 (3): pzab287. PubMed Abstract | Publisher Full Text | Free Full Text Campbell KL, Winters-Stone KM, Wiskemann J, et al. : Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019; 51 (11): 2375–2390. PubMed Abstract | Publisher Full Text | Free Full Text Capozzi LC, Daun JT, Francis GJ, et al. : Feasibility and implementation of an oncology rehabilitation triage clinic: assessing rehabilitation, exercise need, and triage pathways within the alberta cancer exercise-neuro-oncology study. Curr Oncol. 2023; 30 (7): 6220–6245. PubMed Abstract | Publisher Full Text | Free Full Text Coletta AM, Campbell A, Morris GS, et al. : Synergy between licensed rehabilitation professionals and clinical exercise physiologists: optimizing patient care for cancer rehabilitation. Semin Oncol Nurs. 2020; 36 (1): 150975. PubMed Abstract | Publisher Full Text Courneya KS, Vardy JL, O’Callaghan CJ, et al. : Structured exercise after adjuvant chemotherapy for colon cancer. N Engl J Med. 2025; 393 (1): 13–25. PubMed Abstract | Publisher Full Text Covington KR, Marshall T, Campbell G, et al. : Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. Support Care Cancer. 2021; 29 (11): 6469–6480. PubMed Abstract | Publisher Full Text | Free Full Text Dennett AM, Peiris CL, Shields N, et al. : From cancer rehabilitation to recreation: a coordinated approach to increasing physical activity. Phys Ther. 2020; 100 (11): 2049–2059. PubMed Abstract | Publisher Full Text Department of Health: National cancer strategy 2017–2026.2017; (Accessed: June 26, 2025). Lawler M, Davies L, Oberst S, et al. : European groundshot—addressing Europe’s cancer research challenges: a Lancet Oncology Commission. Lancet Oncol. 2023; 24 (1): e11–e56. PubMed Abstract | Publisher Full Text Mina DS, Sabiston CM, Au D, et al. : Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement. Curr Oncol. 2018; 25 (2): 149–162. PubMed Abstract | Publisher Full Text | Free Full Text Nadler M, Bainbridge D, Tomasone J, et al. : Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators. Support Care Cancer. 2017; 25 (7): 2297–2304. PubMed Abstract | Publisher Full Text Pergolotti M, Deal AM, Lavery J, et al. : The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. J Geriatr Oncol. 2015; 6 (3): 194–201. PubMed Abstract | Publisher Full Text | Free Full Text Riordan JMO, McCullagh R, Sheill G, et al. : A qualitative study exploring the desired elements, potential benefits, barriers and facilitators of, a physiotherapy-led exercise-based service in a primary care setting to improve the quality of life of people with metastatic breast cancer. Physiotherapy. 2025: 101812. Publisher Full Text Schmitz KH, Chongaway A, Saeed A, et al. : An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology. Support Care Cancer 2024; 32 (4): 259. Publisher Full Text Schmitz KH, Stout NL, Maitin-Shepard M, et al. : Moving through cancer: setting the agenda to make exercise standard in oncology practice. Cancer. 2021; 127 (3): 476–484. PubMed Abstract | Publisher Full Text | Free Full Text Stout NL, Brown JC, Schwartz AL, et al. : An exercise oncology clinical pathway: screening and referral for personalized interventions. Cancer. 2020; 126 (12): 2750–2758. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (1) Version 2 VERSION 2 PUBLISHED 10 Mar 2026 Revised Comment ADD YOUR COMMENT Version 1 VERSION 1 PUBLISHED 27 Oct 2025 Discussion is closed on this version, please comment on the latest version above. Author Response 10 Mar 2026 Marie Tierney , Trinity St James's Cancer Institute, Dublin, Ireland 10 Mar 2026 Author Response Thank you very much for your comments. We are grateful for your thoughtful feedback, which will help strengthen the reporting of the study and guide the development of our future ... Continue reading Thank you very much for your comments. We are grateful for your thoughtful feedback, which will help strengthen the reporting of the study and guide the development of our future work. This revised version incorporates your feedback. The Introduction has been updated to clarify the contribution of exercise to quality of life outcomes. Additional detail has been added regarding PERCS 1.0 triage pathways, including Level 1-3 descriptions and referral proportions. The Methods section now defines Public and Patient Involvement (PPI) at first mention. No changes were made to study design or conclusions. Thank you very much for your comments. We are grateful for your thoughtful feedback, which will help strengthen the reporting of the study and guide the development of our future work. This revised version incorporates your feedback. The Introduction has been updated to clarify the contribution of exercise to quality of life outcomes. Additional detail has been added regarding PERCS 1.0 triage pathways, including Level 1-3 descriptions and referral proportions. The Methods section now defines Public and Patient Involvement (PPI) at first mention. No changes were made to study design or conclusions. Competing Interests: No competing interests were disclosed. Close Report a concern Discussion is closed on this version, please comment on the latest version above. Author details Author details 1 Trinity St James's Cancer Institute, Dublin, Ireland 2 Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland 3 Department of Physiotherapy, St James's Hospital, Dublin, Ireland 4 Centre for Health Research Methodology, School of Nursing & Midwifery, University of Galway, Galway, Ireland 5 Institute for Clinical Trials, College of Medicine, Nursing & Health Sciences, University of Galway, Galway, Ireland 6 Independent Public and Patient Involvement Contributor, Ireland, Ireland 7 National Cancer Control Programme, Health Service Executive, Dublin, Ireland 8 Department of Surgery, St James's Hospital, Dublin, Ireland Marie Tierney Roles: Conceptualization, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Gráinne Sheill Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Elaine Toomey Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Dearbhaile O'Hare Roles: Methodology, Writing – Review & Editing Tom Conway Roles: Methodology, Writing – Review & Editing Louise Mullen Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Claire L Donohoe Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Emer Guinan Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This research was funded by the Health Research Board Ireland [ILP-HSR-2024-011]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 10 Mar 2026, 8:115 https://doi.org/10.12688/hrbopenres.14272.2 version 1 Published: 27 Oct 2025, 8:115 https://doi.org/10.12688/hrbopenres.14272.1 Copyright © 2026 Tierney M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Tierney M, Sheill G, Toomey E et al. Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.12688/hrbopenres.14272.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 10 Mar 2026 Revised Views 0 Cite How to cite this report: Hardcastle SJ. Reviewer Report For: Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.21956/hrbopenres.15828.r54104 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-115/v2#referee-response-54104 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Apr 2026 Sarah J Hardcastle , Sheffield Hallam University, Sheffield, UK Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15828.r54104 The proposed study contributes to an important area of work within exercise oncology concerning the implementation pathways for physical activity promotion. The introduction could be strengthened with a couple of additions: (i) reference to the national and international physical ... Continue reading READ ALL The proposed study contributes to an important area of work within exercise oncology concerning the implementation pathways for physical activity promotion. The introduction could be strengthened with a couple of additions: (i) reference to the national and international physical activity guidelines for those living with and beyond cancer (and in doing so, defining what is meant be physically inactive patients) and (ii) reference to the previous research in Ireland in relation to the challenges to physical activity promotion and recommendations for implementation [1,2]. For example, the recently published scoping review of physical activity and exercise initiatives for cancer patients in Ireland for the National Cancer Control Programme and associated (some of this review focused on challenges and solutions has also been published [1]). This is highly relevant given the findings on limited access to appropriate physical activity interventions for cancer patients in Ireland, and also to poor uptake to and high attrition to cancer specific community-based exercise programme . Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Hardcastle S, Sheehan P, Kehoe B, Harrison M, et al.: Promoting Physical Activity to Cancer Survivors in Practice: Challenges and Solutions for Implementation. Cancers . 2025; 17 (5). Publisher Full Text 2. Cantwell M, Walsh D, Furlong B, Moyna N, et al.: Healthcare professionals' knowledge and practice of physical activity promotion in cancer care: Challenges and solutions. European Journal of Cancer Care . 2018; 27 (2). Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: health behaviour change, exercise and health psychology, adherence, exercise oncology. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hardcastle SJ. Reviewer Report For: Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.21956/hrbopenres.15828.r54104 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-115/v2#referee-response-54104 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 27 Oct 2025 Views 0 Cite How to cite this report: Rossi F. Reviewer Report For: Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.21956/hrbopenres.15700.r51858 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-115/v1#referee-response-51858 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 12 Dec 2025 Francesca Rossi , Regina Margherita Children’s Hospital, Turin, Italy Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15700.r51858 The study design is correctly identified in the title. The background, aims, objectives and methods of the study are all crearly described. However, I have a few suggestions to help the authors improve their paper: Abstract: ... Continue reading READ ALL The study design is correctly identified in the title. The background, aims, objectives and methods of the study are all crearly described. However, I have a few suggestions to help the authors improve their paper: Abstract: In the conclusion section of the abstract, you assert that the study “will contribute to ongoing efforts to improve quality of life for cancer survivors”. However, you do not mention the impact of exercise on quality of life anywhere else in the text. You should include this information in the introduction, where you discuss the role of exercise. Introduction: You refer to the results of the PERCS 1.0 for the majority of your sample, which consisted of patients requiring support to become physically active and to those who were referred to community exercise programmes. However, these are incomplete data. It would also be interesting for the reader to know also the percentage of patients who were referred to independent exercise programmes and to physiotherapist-led rehabilitation programmes. Methods: You should explain what the acronym “PPI” stands for the first time you mention it. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: pediatric oncology rehabilitation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rossi F. Reviewer Report For: Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.21956/hrbopenres.15700.r51858 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-115/v1#referee-response-51858 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (1) Version 2 VERSION 2 PUBLISHED 10 Mar 2026 Revised Comment ADD YOUR COMMENT Version 1 VERSION 1 PUBLISHED 27 Oct 2025 Discussion is closed on this version, please comment on the latest version above. Author Response 10 Mar 2026 Marie Tierney , Trinity St James's Cancer Institute, Dublin, Ireland 10 Mar 2026 Author Response Thank you very much for your comments. We are grateful for your thoughtful feedback, which will help strengthen the reporting of the study and guide the development of our future ... Continue reading Thank you very much for your comments. We are grateful for your thoughtful feedback, which will help strengthen the reporting of the study and guide the development of our future work. This revised version incorporates your feedback. The Introduction has been updated to clarify the contribution of exercise to quality of life outcomes. Additional detail has been added regarding PERCS 1.0 triage pathways, including Level 1-3 descriptions and referral proportions. The Methods section now defines Public and Patient Involvement (PPI) at first mention. No changes were made to study design or conclusions. Thank you very much for your comments. We are grateful for your thoughtful feedback, which will help strengthen the reporting of the study and guide the development of our future work. This revised version incorporates your feedback. The Introduction has been updated to clarify the contribution of exercise to quality of life outcomes. Additional detail has been added regarding PERCS 1.0 triage pathways, including Level 1-3 descriptions and referral proportions. The Methods section now defines Public and Patient Involvement (PPI) at first mention. No changes were made to study design or conclusions. Competing Interests: No competing interests were disclosed. Close Report a concern Discussion is closed on this version, please comment on the latest version above. keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 10 Mar 26 read Version 1 27 Oct 25 read Francesca Rossi , Regina Margherita Children’s Hospital, Turin, Italy Sarah J Hardcastle , Sheffield Hallam University, Sheffield, UK Comments on this article All Comments (1) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Hardcastle S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Apr 2026 | for Version 2 Sarah J Hardcastle , Sheffield Hallam University, Sheffield, UK 0 Views copyright © 2026 Hardcastle S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The proposed study contributes to an important area of work within exercise oncology concerning the implementation pathways for physical activity promotion. The introduction could be strengthened with a couple of additions: (i) reference to the national and international physical activity guidelines for those living with and beyond cancer (and in doing so, defining what is meant be physically inactive patients) and (ii) reference to the previous research in Ireland in relation to the challenges to physical activity promotion and recommendations for implementation [1,2]. For example, the recently published scoping review of physical activity and exercise initiatives for cancer patients in Ireland for the National Cancer Control Programme and associated (some of this review focused on challenges and solutions has also been published [1]). This is highly relevant given the findings on limited access to appropriate physical activity interventions for cancer patients in Ireland, and also to poor uptake to and high attrition to cancer specific community-based exercise programme . Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Hardcastle S, Sheehan P, Kehoe B, Harrison M, et al.: Promoting Physical Activity to Cancer Survivors in Practice: Challenges and Solutions for Implementation. Cancers . 2025; 17 (5). Publisher Full Text 2. Cantwell M, Walsh D, Furlong B, Moyna N, et al.: Healthcare professionals' knowledge and practice of physical activity promotion in cancer care: Challenges and solutions. European Journal of Cancer Care . 2018; 27 (2). Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise health behaviour change, exercise and health psychology, adherence, exercise oncology. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Hardcastle SJ. Peer Review Report For: Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.21956/hrbopenres.15828.r54104) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-115/v2#referee-response-54104 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rossi F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 12 Dec 2025 | for Version 1 Francesca Rossi , Regina Margherita Children’s Hospital, Turin, Italy 0 Views copyright © 2025 Rossi F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study design is correctly identified in the title. The background, aims, objectives and methods of the study are all crearly described. However, I have a few suggestions to help the authors improve their paper: Abstract: In the conclusion section of the abstract, you assert that the study “will contribute to ongoing efforts to improve quality of life for cancer survivors”. However, you do not mention the impact of exercise on quality of life anywhere else in the text. You should include this information in the introduction, where you discuss the role of exercise. Introduction: You refer to the results of the PERCS 1.0 for the majority of your sample, which consisted of patients requiring support to become physically active and to those who were referred to community exercise programmes. However, these are incomplete data. It would also be interesting for the reader to know also the percentage of patients who were referred to independent exercise programmes and to physiotherapist-led rehabilitation programmes. Methods: You should explain what the acronym “PPI” stands for the first time you mention it. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise pediatric oncology rehabilitation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Rossi F. Peer Review Report For: Implementing the Personalised Exercise Rehabilitation in Cancer Survivorship (PERCS) Triage and Referral System in Ireland: Protocol for a Qualitative Stakeholder Study [version 2; peer review: 2 approved] . HRB Open Res 2026, 8 :115 ( https://doi.org/10.21956/hrbopenres.15700.r51858) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-115/v1#referee-response-51858 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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