A "well-kept secret": facilitators and barriers to occupational therapy referral as a component of supportive cancer care in the United States.

INTRODUCTION: People living with and beyond cancer often experience persistent physical, cognitive, psychosocial, and functional challenges that require supportive rehabilitation across the cancer continuum. Occupational therapy (OT) can address these needs by supporting daily functioning, participation, self-management, and quality of life; however, OT remains underutilized in cancer care. Because access to OT often depends on referral decisions made by oncology professionals, understanding how referral sources perceive OT and navigate referral processes is essential for improving timely access to supportive cancer-care services. This study explored cancer-care professionals' perspectives on barriers, facilitators, and solutions to strengthen OT referral as part of supportive cancer-care delivery for persons living with and beyond cancer. METHODS: This grounded-theory-informed, qualitative, multiple-case study included four videoconference focus groups and 17 participants. Data were analyzed using Corbin and Strauss's three-stage approach. A final logic diagram was developed to organize multilevel barriers and facilitators and to generate theoretical propositions regarding how referral sources' knowledge, OT visibility, organizational processes, and system-level constraints shape OT referral decision-making. RESULTS: Three main themes emerged: (1) Facilitators included referral sources' knowledge of OT's scope and organizational processes, and the integration of OT into cancer-care protocols; (2) Barriers included insufficient knowledge and awareness of OT's role, low prioritization of functional concerns, limited OT availability in cancer settings, and system- and patient-level obstacles, such as insurance costs and clinic workflow constraints; and (3) Solutions emphasized increasing OT presence in infusion clinics and community settings, enhancing interdisciplinary collaboration, and clarifying OT's unique contributions through targeted education and marketing. These findings highlight missed opportunities for timely, coordinated supportive rehabilitation within cancer care. CONCLUSION: Despite recognition of OT's potential value, multiple multilevel barriers limit access to OT services for cancer survivors in the US. Addressing these barriers requires coordinated strategies, including embedding OT practitioners within interdisciplinary cancer-care teams, expanding service delivery models, and improving awareness among referral sources. These strategies may support earlier identification of functional needs and improve access to timely, coordinated supportive rehabilitation across the cancer continuum.