Prehabilitation in cancer care: patients’ ability to prepare for major abdominal surgery

Abstract

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.

PREsurgery thoughts – thoughts on prehabilitation in oncologic gynecologic surgery, a qualitative template analysis in older adults and their healthcare professionals

“…Patients actually did put an extra effort into preparing themselves, as they became aware of the small actions they could do that could be beneficial. They were able to increase their weekly exercise significantly [31]. However, not feeling well or being in bad physical and/or psychological shape was a limitation for following the advice, which was also mentioned as a potential barrier in our study and by Polen-De et al [29,30].…”

Incidence, treatment, and survival trends in older versus younger women with epithelial ovarian cancer from 2005 to 2018: A nationwide Danish study

“…Geriatric screening, comprehensive geriatric assessment, and prehabilitation are relatively new approaches to assess and improve older patients' conditions. Optimizing old and frail patients with tailored geriatric interventions to ultimately enable surgery might narrow the survival gap between the older patients and their younger counterparts [36,37]. Although results from randomized controlled trials regarding the benefit of such approaches in EOC patients lack, both the American Society of Clinical Oncology and the International Society of Geriatric Oncology recommend geriatric assessment in all patients ≥65 years receiving oncologic treatment [38,39].…”

What matters to you? An investigation of patients’ perspectives on and acceptability of prehabilitation in major cancer surgery

“…However, so far cancer patients' perspectives on prehabilitation have been insufficiently studied and knowledge is lacking concerning the acceptability of changing behaviour in relation to prehabilitation (McDonald et al, 2019). On the basis of this research gap, we carried out a project (Beck et al, 2019(Beck et al, , 2020a(Beck et al, , 2020b with the overall aim of understanding perspectives on and acceptability of prehabilitation among patients undergoing complex abdominal cancer surgery, in order to enhance patientcentredness in relation to prehabilitation.…”