Implementation of prehabilitation in colorectal cancer surgery: qualitative research on how to strengthen facilitators and overcome barriers

Abstract

Purpose Prehabilitation is increasingly offered to patients with colorectal cancer (CRC) undergoing surgery as it could prevent complications and facilitate recovery. However, implementation of such a complex multidisciplinary intervention is challenging. This study aims to explore perspectives of professionals involved in prehabilitation to gain understanding of barriers or facilitators to its implementation and to identify strategies to successful operationalization of prehabilitation. Methods In this qualitative study, semi-structured interviews were performed with healthcare professionals involved in prehabilitation for patients with CRC. Prehabilitation was defined as a preoperative program with the aim of improving physical fitness and nutritional status. Parallel with data collection, open coding was applied to the transcribed interviews. The Ottawa Model of Research Use (OMRU) framework, a comprehensive interdisciplinary model guide to promote implementation of research findings into healthcare practice, was used to categorize obtained codes and structure the barriers and facilitators into relevant themes for change. Results Thirteen interviews were conducted. Important barriers were the conflicting scientific evidence on (cost-)effectiveness of prehabilitation, the current inability to offer a personalized prehabilitation program, the complex logistic organization of the program, and the unawareness of (the importance of) a prehabilitation program among healthcare professionals and patients. Relevant facilitators were availability of program coordinators, availability of physician leadership, and involving skeptical colleagues in the implementation process from the start. Conclusions Important barriers to prehabilitation implementation are mainly related to the intervention being complex, relatively unknown and only evaluated in a research setting. Therefore, physicians’ leadership is needed to transform care towards more integration of personalized prehabilitation programs. Implications for cancer survivors By strengthening prehabilitation programs and evidence of their efficacy using these recommendations, it should be possible to enhance both the pre- and postoperative quality of life for colorectal cancer patients during survivorship.

Evaluation of interdisciplinary care pathway implementation in older elective surgery patients

“…Our study builds upon existing literature examining interventions to improve quality of geriatric surgical care in an interdisciplinary setting. [17][18][19][20][21] In contrast to retrospective studies, including work from our group, assessing effectiveness of interdisciplinary care pathway implementation in older surgical patients through compliance rates and clinical outcomes, such as delirium rate and hospital length of stay, 10,22,23 we performed a qualitative evaluation of clinician experiences concurrent with our intervention implementation to reveal areas for improvement and expansion. In a CFIR evaluation of ERAS implementation for joint replacement patients, strong belief in the relative advantages compared to standard care encouraged participants to perform the protocols.…”

Multimodal Prehabilitation in Patients Undergoing Complex Colorectal Surgery, Liver Resection, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Pilot Study on Feasibility and Potential Efficacy

“…This might be a logical consequence of the fact that no alternations were made in the preoperative workup and surgery planning since this was only a pilot study. Insufficient time for prehabilitation has been reported earlier as a barrier for prehabilitation in CRC surgery in non-academic hospitals [ 28 ], as implementation and execution of multimodal prehabilitation requires involvement and cooperation of many different healthcare providers. Although it is not desirable to adjust guidelines on surgery planning until the true effect of prehabilitation has been determined in complex primary and metastatic CRC surgery, future implementations of prehabilitation should acknowledge this barrier.…”

Evaluation of Postoperative Results After a Presurgical Optimisation Programme

“…In other models, the nurse takes part only in the coordination and follow-up of interventions, and the assessment of the patient needs is carried out by medical specialists (9). It has been reported that a healthcare professional acting as a coordinator facilitates implementation (32). Empowering a nurse (with adequate training and supervision) to assume roles historically performed by other medical professionals expedites access to therapies and simpli es the management of complex patients (27).…”