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Table 2 Quotations describing barriers to provision/receipt of preoperative PFMT

From: Barriers and enablers to the provision and receipt of preoperative pelvic floor muscle training for men having radical prostatectomy: a qualitative study

1. Social/Professional role & beliefs about capabilities  
  (There is) a very limited role (for GPs to influence provision/receipt of PFMT), because again, it’s got to be initiated by the specialists. (General Practitioner 2)
  The pathway today, we find that it's a little bit difficult is, once the patient get's onto (a) specialist's care, we find often we don't see the patient coming back to us for a little while, and quite often it's… already (having had) a prostatectomy. (General Practioner 3)
  I just don't get the referrals to see (men for PFMT), which is probably because doctors are not aware that I provide the treatment, which is again, probably because I never publicise that I provide it. (Physiotherapist (Public Sector) 1)
  … there I suppose hasn't been an opportunity to treat male patients. I think it's through tradition that we have just received female referrals, and hence there hasn't been any consultation with specialists, nurses, etc. who are involved in patients who have prostatectomies… (Physiotherapist (Public Sector) 3)
  There's no reason that people … assuming they've been given the correct information, cannot get the appropriate exercises either through the DVDs, which are available off the net and through the Cancer Association or Council or whatever it is, and take it from there. (Patient 3)
2. Knowledge/skills  
  And there’s no facility available in the public sector, for them to participate in preoperative pelvic floor exercises. (Urological Cancer Surgeon 3)
  I don't think they (GPs) appreciate the situation (that urinary incontinence may be a complication of radical prostatectomy). They only know what they read in the lay media. (General Practitioner 2)
  There are no formal qualifications in men's health that you can get, like there are for women's health, so for example, there is a postgraduate program for women's health and continence in Melbourne, there's no male equivalent for that… (Physiotherapist (Private Sector) 5)
  They (the surgeon) just said, 'you have prostate cancer, what are you going to do about it?' And then you had to make a choice out of the options they gave you, but nothing was ever said about pelvic floor exercises. (Patient 2)
  I've heard of pelvic floor exercises before, but they're all for women. They're not things that men do. (Patient 1)
3. Environmental context and resources  
  It's just staffing, it's our lack of resources that make it difficult… which would make it difficult with a new service. Not difficult, (but) challenging. Staff. (Physiotherapist (Public Sector) 4)
  I mean some of these public patients are really poor, they don't have any money. And you can't get blood out of a stone, so if they haven't got the money, they don't do it. (Urological Cancer Surgeon 3)
  Some of these guys are so obsessed with their daily timetables they barely have enough time to take time off to do their operation, let alone do other things that they don't perceive are as important, perhaps as important as they are. (Urological Cancer Surgeon 3)
4. Memory, attention and decision processes  
  … a diagnosis of prostate cancer is confronting for most men, and then the discussion on the treatment and how it affects the quality of life is very daunting. And in my experience, the obsession with cancer and the obsession with getting rid of the cancer tends to dominate the whole focus. (Urological Cancer Surgeon 3)
  And that’s where I think a lot of it falls through, that you’re missing it (the referral to a provider of PFMT) at the front, where the (receptionist are), they’re so busy… (Urological Cancer Nurse 1)
5. Social influences (Norms)  
  Look, I haven't been instructed to see men. So I haven't been asked by… we haven't had any pressure put on from elsewhere, onto my boss, who hasn't then put pressure onto me. (Physiotherapist (Public Sector) 2)
6. Beliefs about consequences  
  … if you take on a new service, then what happens to your other acute patients? So then you need to either increase your staffing, or increase your KPI (key performance indicator) for your other acute patients, so you’re dropping the standard. (Physiotherapist (Public Sector) 3)
7. Additional patient-related barriers  
  There are patients who … just want to do the bare minimum. There are patients to whom you even say, ‘Look, you’ve got cancer, you need to be operated on, …,’ they don’t care. (Urological Cancer Surgeon 2)