Sample Characteristics
This study included 13 FCPC coaches (all male) representing 12 different soccer clubs and FCPC teams across Denmark. They served as FCPC coaches from one to eight years, or an average of 2.68 years each. Ten currently coached but three no longer did so. Two of the included coaches were FCPC soccer players who had been asked to coach when a former FCPC coach resigned. Table 2 presents participant characteristics.
Table 2 Participant characteristics (n = 13)
Characteristic
|
n (unless stated otherwise)
|
FCPC coach
Current
Prior
|
10
3
|
Age, mean in years (min-max)
|
60 (26-85)
|
Time as FCPC coach, mean in years (min-max)
|
2.68 (1.0-8.0)
|
Prior FCPC soccer player
|
2
|
Prostate cancer diagnosis
|
3
|
Previously played soccer
|
10
|
Previously coached soccer
|
10
|
Inhabitants of the city of the local club
>200.000
<60.000
|
6
7
|
Characteristics of Clubs/Teams
Local soccer clubs have a high degree of autonomy regarding the organization and execution of FCPC, which is reflected in our sample. Four of the included coaches represented FCPC teams that comprised various groups of men, e.g., healthy seniors or men with other types of chronic illnesses, while one FCPC coach permitted two men to join who had approached him even though they had other types of cancer because no other community-based rehabilitation interventions were available.
Analysis of Findings
The results of the analysis resulted in five overall categories and 10 subcategories (Table 3).
Table 3 Results of the analysis
Subcategories
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Category
|
- Preparing to coach a clinical population
- Convenience of using well-established soccer clubs
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Enabling training of a clinical population in a community setting
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- Motivating factors
- Personal investment and gain
|
Dedication based on commitment
|
- Adjusting the program to fit the players’ needs
- Facilitating social community
|
Coaching on the players’ terms
|
- Illness in the foreground vs. illness in the background
- Managing illness progression and deaths
|
Navigating the illness
|
- Unappealing infrastructure
- Finances and retaining coaches
|
Ensuring sustainability
|
Enabling Training of a Clinical Population in a Community Setting
While the FCPC coaches generally expressed feeling confident in their delivery of soccer training for men with prostate cancer, largely due to their extensive experience as soccer coaches, they believe that it does require some form of formal training to coach a clinical population in the community.
Preparing to coach a clinical population
Across interviews, the coaches described how they – before taking part in the one-day FCPC course and before meeting the men – were concerned about what it would be like to coach a clinical population:
C3 Can you joke about the disease? What can they actually do physically? (…) What if someone gets sick along the way? How the hell am I supposed to deal with that as a coach?
However, participants described feeling adequately prepared after completing the one-day FCPC course, which they agreed should be mandatory. Specifically, coaches described feeling reassured that they would be able to deliver a product that respected the population’s specific needs:
C2 They could otherwise just as well play on a regular team, on a regular pitch, as a soccer player in any other club.
A few coaches said that issues related to disease, side effects, and potential deaths made them apprehensive:
C5 The healthcare staff has to be on watch; they have to be sure about what we can do. And that might make you a bit nervous, causing you to think, ‘Oh no, what might I do wrong?
Nevertheless, participants described how their worries disappeared once they met the players, who, according to participants, showed up in high spirits eager to play soccer, leading to an experience shared by many coaches, who stated that FCPC is easier in practice than in theory.
Some described staying in contact with other FCPC coaches or the doctors and nurses they met during the FCPC course and appreciated the possibility of asking questions in case of any uncertainty and/or doubts about prostate cancer.
Convenience of using well-established soccer clubs
Participants described the fact that FCPC was designed and delivered in collaboration with and in the context of well-established local soccer clubs as essential to providing legitimacy and securing the necessary practical resources of value to the sustainability of the program and the coaches’ responsibilities, for instance, changing facilities and booking the football pitch:
C2 There’s a clubhouse run by volunteers who make sure that when we practice, even though no one else is there, there’s always someone available to serve coffee, tea, beer, or other beverages – EVERY single time!
The coaches also described that the embeddedness of the FCPC program within established local clubs constitutes a vital source for attracting coaches to FCPC because most of them had been affiliated with their club for decades prior to FCPC. Only two coaches said that their FCPC teams largely functioned as isolated silos, while the others talked about how their FCPC teams were an embedded, integral part of the local club, which the coaches believed positively influences the players’ perception of being taken seriously, as well as their own:
C3 I’m a busy coach around here, so it’s great to know that the people making the decisions also think that it has a purpose and think that it’s important that we’re part of the club’s makeup.
Dedication based on commitment
Regarding their motivation to take on the role of coach, participants described a general feeling of being dedicated to improving people’s physical abilities. Through FCPC and a commitment to the men on their team, they experienced an unprecedented sense of duty and witnessed how the players benefited and found joy in the game, which, in turn, supported the coaches’ ongoing dedication.
Motivating factors
Several coaches reported that they were headhunted to participate when the FCPC team was established at their local club. Presented with the idea of coaching men with prostate cancer, participants described an aspiration to provide people of all ages with opportunities to participate in and to experience the benefits and enjoyment that derive from physical activity:
C11 This is what sports is all about, that you can differentiate to find out what’s suitable for everything and everyone. So, I just hope that more people would like to do sports, also the elderly, and that they won’t feel intimidated by it, so they don’t just sit at home on the coach and get older than they have to be.
The retired coaches also said that they were motivated by wanting to have more to do during retirement while also taking care of their own need to exercise, while others found that being or knowing someone diagnosed with prostate cancer was motivating. Some of the younger coaches mentioned that writing FCPC coach on their resume might be of value later in their professional career.
Personal investment and gain
The participants said that they invested a considerable amount of time in and were committed to FCPC, including keeping in constant contact with the players, driving long distances to and from practice at the soccer club, socializing before and after practice, and participating in social events. The resources they invest are described as being repaid as good experiences, new friendships, and personal enrichment because the player’s excitement was contagious, offering a new perspective on daily life, insights, and an appreciation of the gifts life has to offer:
C10 You get a look at daily life when you work with both the elderly and a group of people who are ill, people who just show up for practice with enthusiasm and high spirits, despite their circumstances.
Coaching on the Players’ Terms
The coaches, who described FCPC as having two equal purposes, i.e., to facilitate exercise and to facilitate community, said that the overall responsibility of the coach is to guarantee that the program is executed according on the players’ terms to promote adherence.
Adjusting the program to fit the players’ needs
Balancing the differences in level, age, physical ability, and mental state, while giving everyone the opportunity to improve their level of fitness, is described as an important and exciting coaching challenge. Physical exercise is highlighted as important due to both the health and social benefits:
C9 I’ll be damned if it doesn’t give some of them a sense of pride when they say that they are soccer players.
The coaches described initially adhering strictly to the FCPC training manual, though later using it more as a framework that they added features to from their catalogue as experienced coaches to meet the players’ preferences and thus ensure continued motivation:
C3 The players would rather mainly play soccer then do too much fitness training, so I adapt what I do in relation to that.
Continuous adherence to the manual took place chiefly to reduce the risk of injuries, which the coaches primarily stated to attribute to the men’s advanced age rather than their cancer diagnosis. Some coaches introduced standing in a circle before practice to discuss any aches and pains and the status of their illness. In this context, coaches described their role as less authoritarian than it would have been in case of players who were healthy and/or younger. Specifically, coaches said that they trusted that players knew what was best for themselves and that their foremost task was to meet the participants on their terms:
C13 You can just show up tired and say, ‘My treatment has knocked me flat, but I’d like to take part as best I can’.
Facilitating social community
According to the coaches, the social community is the most important aspect for the players, which is why they consider it their most prominent goal to adapt the training and prioritize activities that support the players’ sense of camaraderie. The coaches described how they consciously make an effort to support an inclusive environment so that the community can grow, for instance, by encouraging people to meet for breakfast before practice or to sit and relax together afterwards to talk over a cup of coffee or a beer.
The coaches believed that they bear a special responsibility for creating an atmosphere of mutual caring, both in terms of illness and soccer:
C6 One guy showed up who was just past 60, and he had never played soccer in his entire life (…) he showed up with NO experience whatsoever! And already after a few months, he practiced and received special instruction (…) so we also actually taught the guy to play football. And the support that the others gave him! Wow, he was showered with PRAISE. People cheered wildly whenever he didn’t fall and managed to kick the ball to another player.
Navigating the Illness
The amount of prominence the disease is given and how the related challenges are handled varies between coaches, but also changed as they get to know the players and found their personal coaching style. A central cause for concern among the coaches was how to deal with a worsening of the disease and death.
Illness in the foreground vs. illness in the background
The coaches distinguished between their job and that of the healthcare professionals. They respected the healthcare staff’s expertise and did not wish to intrude on it, preferring not to burden the players with illness-related talk in an effort to balance how much attention the illness was given. Some coaches described consciously holding back but mentioned talking about the illness was a natural corollary:
C4 For the most part, the guys manage on their own (…) when you hang out in the changing room, or you have a beer afterwards and chat, then lots of things come up.
Other coaches mentioned how they actively supported conversations about illness and that an exchange of experiences took place, for example, on walk and talks:
C5 Some people have to wear adult briefs, some have had a sphincter operation, and others have a stoma, those are the breaks when you practice with us, but you have to create room for people to also be able to show concern.
Coaches with teams solely comprising individuals with prostate cancer described a strong bond existing between the players, where nothing is off limits and where jokes are allowed about weight gain, impotence, and incontinence, which means that players would not hesitate to shout, “Damn this diaper is rubbing me raw!”. The same openness does not appear to be present or possible in clubs where the FCPC includes players who do not have prostate cancer:
C8 That’s one of the reasons why some of the guys already put on their workout clothes before they arrive.
Managing illness progression and deaths
The coaches indicated that they were not generally concerned about the men’s illness, but that when a player was considerably affected by side effects or disease progression, they became somewhat uneasy and maintained extra contact with the player. All coaches voiced concern about possible deaths and how to handle them. Those who experienced deaths described dealing with them together with the players. Some show a sign of respect by sending flowers, attending the funeral and/or performing a ritual to pay tribute to and remember the player who died:
C13 They [the players] show up with a bottle of bitter and glasses, which is something they had planned if one of them died, in order to gather before practice to have a little drink in memory of the one who passed away.
Ensuring Sustainability
Coaches pointed out limits to the sustainability of FCPC, which they largely view as being beyond their influence. This is a source of frustration, prompting them to call for improvements that would allow them to focus their energy and resources on the act of coaching.
Unappealing infrastructure
All coaches emphasized continuous recruitment as a necessary requirement for the longevity of teams due to the fact that players continuously dropout or are absent due to treatment and side effects.
In FCPC clubs located far away from a prostate cancer treatment center or hospital, the coaches explained that recruiting enough men with prostate cancer was nearly impossible, leading them to invite other men to participate:
C1 There were usually about 4-6 players at practice, which is a difficult number if you want to keep practices fun (…) I believe it would have stopped again, causing people to lose the desire to play.
The coaches would like to see guidelines and specific opportunities for how to strengthen the referral and recruitment of new players. In the absence of more specific, formal support and/or instructions in this regard, the coaches described how they discovered and developed alternative ways to recruit, such as regional or national news programs or the local newspaper reporting on FCPC.
Across interviews, the coaches underlined that it is crucial to establish a connection to the local cancer rehabilitation coordinators and the nearest hospital’s urological and oncology wards, in addition to providing information for nurses and doctors about FCPC to ease the referral and recruitment of players. Moreover, coaches believed that the authority of healthcare professionals aids in legitimizing FCPC:
C11 Referrals from a clinician might remove some of the dangers of going to a club and playing soccer.
Finances and retaining coaches
The coaches voiced concerns about the sustainability of funding for the FCPC program. Specifically, they explained that FCPC was initially supported by temporary funding, which meant they were currently dependent on the willingness of their local soccer club to provide ongoing financing.
Some also touched upon the difficulties that exist in terms of recruitment and retention of coaches. Since many coaches are still on the labor market, it is problematic for them to coach because FCPC takes place during the daytime, which is when the target group (60-85 years of age) is most willing to participate in physical activity.
According to the coaches, successful recruitment and retention of coaches depends on whether the local club authorities, other FCPC coaches, and healthcare professionals receive support during the start-up phase. Many FCPC clubs form networks across clubs, which the coaches find valuable because they provide the opportunity to exchange experiences with other coaches.
Lastly, the coaches advise non-professionals who are considering coaching clinical populations. They pointed out that potential coaches primarily need to reflect on whether they are willing to invest their time and that they need to refuse to feel intimidated by the thought that they do not know exactly what to do:
C11 Gain as much knowledge as you possibly can, and then throw yourself into it because then you learn what to do.