Modified Delphi Survey

Purposeful and snowball sampling (21) methods were used to identify potential survey respondents. First, workshop attendees were asked to personally invite three to four individuals from each of the five stakeholder groups via a standardized recruitment email. Second, participants were encouraged to share a link to the study with exercise oncology stakeholders within their network. The link directed participants to information about the study, including the informed consent form. If the respondent provided informed consent, the survey was initiated (Survey Monkey. Palo Alto, CA). The first round of surveys was completed between December 2019 and March 2020, with rounds 2 and 3 completed in October – December 2020 and January 2021 – March 2021, respectively. Respondents to each survey round were invited to participate in the subsequent survey round(s). Reminders to complete each survey round were provided at 30 days and at 14 days prior to the close of each survey.

Demographic data were collected to describe the study sample and verify that respondents were associated with at least one of the primary stakeholder groups. If respondents could not be verified as an eligible stakeholder, their data were excluded from the study (see Spam; Figure 1 ). In round 1, participants were asked to review and rate each of the 14 themes for exercise oncology research and KM defined at the workshop by perceived importance using a 5-point Likert scale (1=not important to 5=very important). For each theme, participants were asked “How important is the following research theme to supporting the implementation and permanent adoption of exercise as a standard of care for cancer patients and survivors?”. Participants were also invited to critique, question, and suggest improvements for each theme using open textboxes. Once the round 1 survey closed, investigators (SA, JST) analyzed the ratings, consolidated the open-ended responses according to the four CPPI elements, and updated the themes using this feedback for re-evaluation in round 2. Only themes with mean ratings ≥4/5 were included in the subsequent survey (22, 23).

In round 2, participants were presented with the average theme importance ratings from round 1 and the updated list of themes. To help respondents differentiate between themes that generally improve outcomes for cancer survivors and those that specifically support exercise implementation (i.e., the purpose of this study), participants were asked to rate the importance of each updated theme in terms of (1) how important the theme’s impacts may be to improving outcomes for cancer survivors and (2) how important the theme’s impacts may be to supporting the implementation of exercise as a standard part of cancer care. To increase the resolution of the ratings, themes were rated on a 7-point Likert scale (ranging from 1=not at all important to 7=extremely important). Participants were also asked to: (1) critique and provide feedback for each theme; (2) rank the importance of the remaining themes from most to least important; and, (3) suggest additional themes for exercise oncology research and KM. Once the round 2 survey closed, investigators (SA, JST) analyzed the ratings, consolidated the feedback, and updated the themes for distribution in the round 3 survey. Only themes with mean ratings ≥5 out of 7 were included in the final survey.

In round 3, participants were presented with the findings from round 2. Participants were asked for a final ranking of the 12 updated themes, with consideration of two key questions: (1) “How likely would achieving the impacts (outcomes) for each Theme influence whether exercise is adopted by the healthcare system as a standard part of cancer care?”; and (2) “How potentially impactful is each Theme compared to others?”.

These questions were prompts for participants to consider the broader context of exercise, oncology, and KM.