Development of a clinical decision support system for exercise prescription among cancer survivors: a modified Delphi study

PURPOSE: Exercise is safe and beneficial for cancer survivors, with evidence-based guidelines supporting its use to improve health-related outcomes. However, access to structured exercise oncology programs remains limited, and available services are typically accessible only for individuals living near major health care centers. The aim of this study was to develop the content and layout of a clinical decision support system (CDSS) that enables the delivery of evidence-based, personalized exercise prescriptions for cancer survivors across a nationwide network of health care institutions in Switzerland. METHODS: A Delphi study involving a diverse panel of clinical experts, including exercise physiologists, oncologists, physiotherapists, and researchers, was conducted. The study was informed by a scoping review of randomized controlled trials in exercise oncology. The participants rated and refined proposals regarding the layout and key components of a CDSS for exercise oncology across three rounds. Consensus was defined as at least 67% agreement among the participants. RESULTS: The Delphi process resulted in the content and layout comprising a measurement set, personalizable exercise prescriptions, SMART goal standardization, and structured safety considerations. Key elements included the integration of progression and overload principles alongside Frequency-Intensity-Time-Type (FITT) criteria and the use of validated patient-reported outcome measures (PROMs) along with additional functional and fitness-related outcomes. CONCLUSION: The content and layout of a CDSS for evidence-based prescriptions in exercise oncology was developed in this study. This CDSS bridges the gap between published evidence and real-world practice, equipping health professionals across Switzerland with a practical tool to deliver safe, effective, and individualized exercise interventions for cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Implementing this CDSS can improve access to consistent, evidence-based exercise oncology services and help reduce geographic disparities for survivors living in rural and other peripheral regions.