To investigate the experiences, thoughts, and feelings that underlie and influence prehabilitation among cancer patients due to undergo major abdominal surgery. Materials and methodsPrior to their surgery, sixteen patients with peritoneal carcinomatosis of colorectal or ovarian origin due to undergo major surgery received oral information and a leaflet with preoperative recommendations. They subsequently participated in individual, semi-structured interviews.Malterud's principles of systematic text condensation were used to analyse the interviews, and the concept of action competence inspired and framed the discussion. ResultsAlthough the patients found themselves in an unpredictable and uncontrollable situation, they nevertheless knew what was important to them. These factors were contextualised in five themes that reflected the experiences, thoughts, and feelings that underlay and influenced their actions: 'Perception of preparation', 'The two-sided preoperative period', 'Home or facility-based prehabilitation', 'Stakeholders in prehabilitation', and 'Reasons for taking action'. Conclusions 2The patients demonstrated action competence in relation to their preoperative preparation.However, in relation to the kind of prehabilitation that required lifestyle changes, their action competence needed to be developed and supported. To do so, it is necessary to ask questions that cover the patients' perspectives of the what, when, where, who, and why of prehabilitation.

Prehabilitation in cancer care: patients' ability to prepare for major abdominal surgery Background: Patients' perspectives on standardised, multimodal prehabilitation programmes showed barriers to adherence. Further investigation of patients' ability to prepare is needed. Aim: To investigate what patients with cancer who were due to undergo major abdominal surgery actually were able to do when provided with preoperative, homebased, multimodal recommendations presented in a leaflet. Methods: Patients from the colorectal-or ovarian cancer centre, who were scheduled for major abdominal surgery, received a leaflet with preoperative recommendations. On a daily basis, the patients filled in what they had completed in relation to these recommendations, so that adherence could be investigated. Additionally, faceto-face interviews were conducted to evaluate patients' experiences of using the leaflet. Malterud's principles of systematic text condensation were used to analyse the interviews. A convergent design was used to merge the quantitative and qualitative data into a combined interpretation presented in the discussion. Results: A total of 53 patients returned a completed leaflet, and five patients were interviewed. In the combined interpretation, patients' ability to prepare was presented through four major domains. The domains were adherence and the importance of support, manageable actions leading to change, preparation in a broader perspective and impediments to preparation and to symptom relief. Conclusions: Patients prepared themselves in various ways, which were not limited to recommendations inspired by multimodal prehabilitation. Patients from the ovarian cancer centre increased their weekly exercise during the preoperative period, which indicates that the leaflet not only functioned as a data collection tool, but also motivated and supported the patients in prehabilitation-related actions. Patients' perspectives on prehabilitation need to be taken into account, when aiming to enhance patient-centredness and adherence.

Prehabilitation refers to the process of making patients fit for surgery with the aim of enabling them to withstand treatment-related stress (Topp et al., 2002). The last decade prehabilitation interventions in patients with cancer have attracted attention, owing to a growing body of evidence indicating beneficial effects on postoperative outcomes (Scheede-Bergdahl et al., 2019). However, in particular, prehabilitation in cancer care represents a challenge, as newly diagnosed cancer patients are going through a stressful and life-changing period of time prior to surgery that often entails feelings such as shock, fear, anger, confusion and powerlessness