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

Abstract

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 novel 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 three themes providing an in-depth understanding of key elements required to develop and promote system-wide delivery of a MCPP: 1) Equipping the team: Capability and capacity, 2) Timing of intervention and delivery timeframe and 3) Systems and processes. Conclusion The system-wide collaborative approach to developing a MCPP 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 intervention delivery in an effort to improve patient outcomes. Iterative, responsive troubleshooting during initial delivery is required to facilitate successful implementation. Further training is required for greater adherence to provision of prescriptive high intensity exercise within the programme, which may further promote enhanced patient outcomes. To enable sustainability of MCPP, ongoing training for professionals and funding is required.

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

“…You're ringing ladies who are maybe 70 or 80 who maybe are bed bound or maybe go out once a week to do their shopping, never been in a gym in their life, so it had to be home-based kind of functional movements that they were used to doing you know. (HCP) (Bingham et al, 2023) HIIT training is very, you know, targeted, you're working on a certain percentage of your max heart rate, you're getting a certain ratio rest, work to rest ratio, it has to be within certain zones… there's no way you're putting somebody with maybe a heart condition or who's obese, bad knees, hips, into a HIIT session and even 30 seconds on 30 seconds off is so general, so I didn't believe it and I'm still very skeptical of it. (HCP) (Bingham et al, 2023) Subtheme 5: Degree of perfection in prehabilitation (32/660, 5%)…”

“…To know, we just, you know, we need funding to provide this service. (HCP) (Bingham et al, 2023) When we first started to talk about this, we did discuss this with the director of hospital services with the assistant director. So, I think at the very beginning, we had buy-in from that level, which was really, really important… I think that that sort of commitment from senior level has been really important, that they were committed and they had given the yes, we want to take this forward has been key to it.…”

“…So, I think at the very beginning, we had buy-in from that level, which was really, really important… I think that that sort of commitment from senior level has been really important, that they were committed and they had given the yes, we want to take this forward has been key to it. (HCP) (Bingham et al, 2023) Subtheme 9: Group effect (33/660, 5%)…”

“…The screening process is very good in that it is a very clear, well-constructed e-referral system and I think that works really well. (HCP) (Bingham et al, 2023) Subtheme 14: Weather (7/660, 1%)…”

“…(Hirschhorn et al, 2013) Given the condition we work with being head and neck cancer, there's a significant proportion of our patients have alcohol-related issues or they're alcohol dependent, so that's part of our initial assessment anyway and we work very closely with the substance misuse team, the alcohol liaison team and it is not something that we're uncomfortable with probing into that area of people's lives and making recommendations and onward referrals, so those were well established anyway. (HCP) (Bingham et al, 2023) Since the need for prehabilitation has not been proven, the selection of patients with a greater significance and urgent need for treatment becomes a consideration.…”