Bioethical Issues in Oncological Physiotherapy: A Multi-Method Analysis

Background: The growing role of physiotherapists in oncological physiotherapy and cancer care has brought ethical challenges to the forefront, particularly when dealing with end-of-life care, communication of prognosis, and balancing clinical benefits with patient autonomy. Despite this, bioethical issues in oncological physiotherapy remain underexplored. Aim: The overarching aim of this doctoral research was to explore and describe the ethical dimensions of physiotherapy practice in oncological physiotherapy, as perceived and experienced by physiotherapists and patients. Specifically, the project sought to document ethically relevant situations, challenges, and reasoning processes emerging in clinical practice and professional education, adopting a descriptive ethics approach. Methods: This doctoral thesis integrates findings from five interrelated studies. The first is a qualitative study exploring the educational trajectory of physiotherapists in oncological physiotherapy. The second is a systematic scoping review identifying and classifying ethical issues in physiotherapy. The third study investigates the specific ethical challenges perceived by Italian physiotherapists working in oncology. The fourth is a mixed-methods analysis combining survey data and focus group interviews to understand how ethical principles influence clinical decision-making in oncological physiotherapy. The fifth study adopts a qualitative design to explore cancer patients’ perspectives on ethically relevant aspects of oncological physiotherapy. Results: Across the studies, key ethical challenges were identified, including informed consent, treatment withdrawal, truth-telling, risk-benefit dilemmas, and cultural influences on care delivery. Physiotherapists reported tensions between compassion, patient autonomy, and systemic constraints. A consistent theme was the need for profession-specific ethical guidance and enhanced education in ethics throughout physiotherapy curricula. Findings also highlighted the relational and embodied nature of physiotherapy as a unique context for ethical reflection. Conclusions: Oncological physiotherapy involves ethically complex situations that require physiotherapists to engage with interpersonal, institutional, and cultural dimensions of care. By offering a descriptive account of how ethical issues are perceived and experienced by clinicians and patients, this thesis provides empirical material that may inform future ethical reflection, education, and normative analysis within physiotherapy, without advancing prescriptive ethical claims.