A Qualitative Study of Patient and Healthcare Provider Perspectives on Building Multiphasic Exercise Prehabilitation into the Surgical Care Pathway for Head and Neck Cancer

Abstract

Head and neck cancer (HNC) surgical patients experience a high symptom burden. Multiphasic exercise prehabilitation has the potential to improve patient outcomes, and to implement it into the care pathway, the perspectives of patients and healthcare providers (HCPs) must be considered. The purpose of this study was thus to gather feedback from HNC surgical patients and HCPs on building exercise into the standard HNC surgical care pathway. Methods: Semi-structured interviews were conducted with patients and HCPs as part of a feasibility study assessing patient-reported outcomes, physical function, and in-hospital mobilization. Interview questions included satisfaction with study recruitment, assessment completion, impact on clinical workflow (HCPs), and perceptions of a future multiphasic exercise prehabilitation program. This study followed an interpretive description methodology. Results: Ten patients and ten HCPs participated in this study. Four themes were identified: (1) acceptability and necessity of assessments, (2) the value of exercise, (3) the components of an ideal exercise program, and (4) factors to support implementation. Conclusion: These findings highlight the value of exercise across the HNC surgical timeline from both the patient and the HCP perspective. Results have informed the implementation of a multiphasic exercise prehabilitation trial in HNC surgical patients.

Attitudes and perceptions of cancer patients and healthcare providers towards prehabilitation: A thematic synthesis

“…This facilitates the implementation of the prehabilitation.

I think we're all really interested and excited and really proud that this is happening for our patients. (HCP) (Daun et al., 2022)

I think you definitely feel like it is another sort of element to the dietetic role that it is because you are part of the MDT [multidisciplinary team] and part of the project, it is a lot more, you feel very valued I suppose and your input very beneficial. (HCP) (Bingham et al., 2023)

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“…I think we're all really interested and excited and really proud that this is happening for our patients. (HCP) (Daun et al., 2022)…”

“…I think we're all really interested and excited and really proud that this is happening for our patients. (HCP) (Daun et al, 2022) I think you definitely feel like it is another sort of element to the dietetic role that it is because you are part of the MDT [multidisciplinary team] and part of the project, it is a lot more, you feel very valued I suppose and your input very beneficial. (HCP) (Bingham et al, 2023) Some healthcare providers do not realize the importance of prehabilitation, especially when they perceive negative patient attitudes when interacting with patients and spontaneously reduce the availability of prehabilitation-related information.…”

A qualitative evaluation of a multi-modal cancer prehabilitation programme for colorectal, head and neck and lung cancers patients

“…Similar partnership arrangements were also reported as a key to success when Greater Manchester adopted a system-wide approach to MCPP [30]. Involvement from key professionals early in programme development and in an on-going manner was crucial to success, alongside ensuring that decision-making occurs in a collaborative and shared manner [22]. Cross-sectoral collaborations, however, can be challenging given differing reporting and funding structures [31].…”

“…For example, some doctors in this study were less aware of the multifaceted components of the programme and known benefits, even within a short timeframe of less than two weeks [27]. Rectifying this is important as patients, both within this study and elsewhere articulate that doctors’ communication on the topic influences their uptake and engagement with MCPP [22]. High coherence can enhance patient recruitment and adherence [28].…”