Prehabilitation services for people diagnosed with cancer in Scotland – Current practice, barriers and challenges to implementation

Provan, Debbie; McLean, Gordon K.; Moug, Susan; Phillips, I.; Anderson, Annie S.

doi:10.1016/j.surge.2021.08.005

Cited by 14 publications

(17 citation statements)

References 20 publications

(16 reference statements)

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“…Professionals were clear on how MCPP could complement and be a vital part of the cancer care continuum. Key facilitators, such as having knowledge that MCPP can positively impact patients' functional and emotional outcomes, along with reducing the economic burden of patient care upon the healthcare budget [5,[25][26] has promoted successful implementation of MCPP. Of note, for some, greater coherence could be facilitated through an enhanced appraisal of the recent growing body of literature surrounding the efficacy of MCPP.…”

Section: Discussionmentioning

confidence: 99%

“…Given the often-short timeframe for MCPP delivery, alongside lack of knowledge of, or changeable, treatment commencement dates presented as challenges for MMCs to collect Time 2 data. Minimising attrition rates of Time 2 data capture is paramount to enhance the evidence base for MCPP [26]. Development and implementation of the MCPP at SET received no additional funding, however a sustained funding model is required to further consolidate, scale-up and integrate pathways for system-wide implementation.…”

Section: Discussionmentioning

confidence: 99%

“…Development and implementation of the MCPP at SET received no additional funding, however a sustained funding model is required to further consolidate, scale-up and integrate pathways for system-wide implementation. Professionals in this study, like that of others [26,38] recognised the need for dedicated funding which extends to sustaining AHP involvement [26], project management and performance data support [38]. Given the success of MCPP already evident [28], there is now a need to align funding to ensure equitable access of MCPPs to all cancer patients.…”

Section: Discussionmentioning

confidence: 99%

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

Bingham¹,

Small

Semple

2022

Preprint

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Background Growing evidence indicates patients’ survivorship outcomes can be enhanced through active engagement in a multi-modal cancer prehabilitation programme (MCPP), although this intervention is not uniformly embedded as a standard of care. MCPP aims to optimise patients physiologically and psychologically for cancer treatments, shorten recovery time, reduce complications, promote healthier lifestyles and improve quality of life. South Eastern Health and Social Care Trust (SET) developed and evaluated a system-wide collaborative approach to MMCP across three tumour groups (colorectal, lung, head and neck cancer). Addressing the lack of qualitative evaluation of MCPPs, this paper explores mechanisms promoting feasibility and acceptability of MCPP from patients’ and interdisciplinary professionals’ perspectives. Methods Semi-structured virtual one-to-one interviews were conducted with 24 interdisciplinary professionals and nine patients. Transcripts were recorded, transcribed verbatim and themes developed using Framework Analysis. Results Analysis of findings identified four themes providing an in-depth understanding of key elements required to develop and deliver a MCPP: 1) Planning: Building the team, 2) Shared vision to develop and tailor the MCPP to meet patient needs, 3) Delivering the MCPP and 4) Moving forward - improving the MCPP. Conclusion The system-wide collaborative approach to developing a MCPP at SET was deemed both feasible and acceptable. Success was attributed to visionary leadership, alongside a diverse group of interdisciplinary professionals being engaged, motivated and committed to improving patient outcomes. Iterative, responsive troubleshooting during delivery facilitated successful implementation. Greater adherence to provision of prescriptive high intensity exercise within the programme may further promote enhanced patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Bingham¹,

Small

Semple

2022

Preprint

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“…Principles and guidance for prehabilitation for cancer were launched in the UK in 2019. The principles were developed by Macmillan Cancer Support, the National Institute for Health and Care Research (NIHR) and The Royal College of Anesthetists' (RCoA)(6) and have been welcomed by many National Health Service (NHS) sites (12). The guidance called for action in several areas including the integration of prehabilitation into clinical pathways for people with cancer, examples of implementation and the development of quality assurance and improvement frameworks (6).…”

Section: Introductionmentioning

confidence: 99%

Identifying quality and inequality in prehabilitation services before cancer surgery: a Delphi study informed by lived and professional experience

Wareing,

Hirst,

Shelton

et al. 2024

Preprint

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Background Preoperative cancer prehabilitation interventions have been described as the practice of enhancing a patient’s functional capacity before surgery, aiming to improve postoperative outcomes. Internationally, it is increasingly recommended for implementation in clinical practice to improve patients’ functional and psychological wellbeing before cancer surgery. There is a gap in evidence on how and where it is delivered, what patients want from interventions and how inequalities in access and resources are addressed. In this study, both people with lived experience of cancer and healthcare professionals created criteria for quality and equitable preoperative cancer prehabilitation. Methods A modified Delphi technique was implemented over three rounds of online questionnaires with prehabilitation professionals (experts by profession) and people with lived experience of cancer (experts by experience). The criteria statements included in the first round of the questionnaire were suggested and developed in a series of co-design workshops. In each Delphi round, participants were asked to rank the statements on a 5-point Likert scale and make suggestions for refinement or additional statements. The consensus rate was defined as at least 75% of participants voting to indicate agreement on each statement. Results A total of 22 participants voted in Delphi questionnaire with a 76% response rate. 63.6% of the participants were ‘experts by experience’ and 36.4% were ‘experts by profession’. The questionnaire started with 54 statements and 60 statements reached consensus. The criteria cover seven themes including developing and delivering prehabilitation, (covering prehabilitation definitions, safety and evaluation processes and interactions with patients), emotional health, nutritional, physical and multi-modal interventions, integrating community-based care and addressing inequalities. Conclusions To the authors’ knowledge, this is the first study that has developed criteria to guide the evaluation and design of prehabilitation interventions before cancer surgery with an emphasis on addressing inequalities, which have been developed by both experts by experience and profession. The criteria enhance the evidence base on patient and healthcare professional preferences for quality and equitable access to prehabilitation interventions. The results will be of interest to researchers, healthcare professionals and service providers interested in designing, evaluating and delivering prehabilitation before cancer surgery.

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“…Qualitative research in cancer prehabilitation primarily focuses on the patient experience or barriers to implementation [13][14][15]. Although there are reported di culties delivering prehabilitation prior to AuSCT [11,12], there is a gap in current literature regarding clinicians' perceptions of enablers and barriers to prehabilitation delivery.…”

Section: Introductionmentioning

confidence: 99%

Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the Autologous Stem Cell Transplant population: A theory-based interview study

Crowe

Edbrooke

Khot

et al. 2022

Preprint

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Purpose Health care professionals (HCP) play a vital role in effectiveness of prehabilitation programs, but information is limited about what assists HCP deliver an effective service. This study evaluated HCP perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to autologous stem cell transplant. Methods Based on the Theoretical Domains Framework (TDF) of behaviour change, we conducted semi-structured interviews, purposively sampling 14 participants (from various healthcare disciplines) at a tertiary cancer centre. Discipline-specific topic guides were created based on the TDF and the behaviours appropriate to each discipline. Interviews were audio-recorded, transcribed verbatim, anonymised, content analysed (grouping, then labelling, thematically similar responses) and classified into theoretical domains. Structured decision rules were used to classify themes as high, medium or low priority. Results Fifty enablers and 31 barriers were identified; of these 26 enablers and 16 barriers classified as high priority. Four domains had the most frequent high-priority enablers: Social professional role and identity (e.g., multidisciplinary teamwork); Beliefs about consequences (e.g., patient benefit); Memory, attention and decision processes (e.g., refer as early as possible); and Environmental context and resources (e.g., electronic medical records are beneficial). High-priority barriers were most frequent in four domains: Memory, attention and decision processes (e.g., conflicting views about who should be referred); Environmental context and resources (e.g., lack of time); Social influences (e.g., families); and Emotions (e.g., patient distress). Conclusion Participants reported more enablers than barriers. Findings can support delivery of prehabilitation programs in hospital settings where uptake remains low.

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Prehabilitation services for people diagnosed with cancer in Scotland – Current practice, barriers and challenges to implementation

Cited by 14 publications

References 20 publications

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

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

Identifying quality and inequality in prehabilitation services before cancer surgery: a Delphi study informed by lived and professional experience

Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the Autologous Stem Cell Transplant population: A theory-based interview study

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