Exploring patient attitudes to behaviour change before surgery to reduce peri‐operative risk: preferences for short‐ vs. long‐term behaviour change

Abstract

Pre-operative intervention to improve general health and readiness for surgery is known as prehabilitation. Modification of risk factors such as physical inactivity, smoking, hazardous alcohol consumption and an unhealthy weight can reduce the risk of peri-operative morbidity and improve patient outcomes. Interventions may need to target multiple risk behaviours. The acceptability to patients is unclear. We explored motivation, confidence and priority for changing health behaviours before surgery for short-term peri-operative health benefits in comparison with long-term general health benefits. A total of 299 participants at three UK hospital Trusts completed a structured questionnaire. We analysed participant baseline characteristics and risk behaviour profiles using independent sample t-tests and odds ratios. Ratings of motivation, confidence and priority were analysed using paired sample t-tests. We identified a substantial prevalence of risk behaviours in this surgical population, and clustering of multiple behaviours in 42.1% of participants. Levels of motivation, confidence and priority for increasing physical activity, weight management and reducing alcohol consumption were higher for peri-operative vs. longer term benefits. There was no difference for smoking cessation, and participants reported lower confidence for achieving this compared with other behaviours. Participants were also more confident than motivated in reducing their alcohol consumption pre-operatively. Overall, confidence ratings were lower than motivation levels in both the short-and long-term. This study identifies both substantial patient desire to modify behaviours for peri-operative benefit and the need for structured pre-operative support. These results provide objective evidence in support of a 'pre-operative teachable moment', and of patients' desire to change behaviours for health benefits in the short term.

Prehabilitation

“…Unhealthy behaviours and lifestyle factors frequently cluster in the same individual and may be particularly common in surgical populations, driving development of surgical pathologies. 13,14 In our recent study, 42% of patients demonstrated two or more risk factors. This emphasises both the possibility of a 'risk multiplier' effect from several risk factors, and the need for multimodal intervention to modify factors simultaneously in the potentially time-pressured preoperative window.…”

“…Our recent research has highlighted a high degree of patient motivation to change behaviour for perioperative benefits, however a comparative lack of confidence identified a need for structured Prehabilitation support. 13 The wider public health opportunity offered by surgery to embed lasting lifestyle change should not be ignored. Effective prehabilitation is person centred, placing the patient at the core of their perioperative journey.…”

“…This emphasises both the possibility of a 'risk multiplier' effect from several risk factors, and the need for multimodal intervention to modify factors simultaneously in the potentially time-pressured preoperative window. 13 Evidence exists suggesting multimodal intervention may be more effective than single or sequential intervention but this is not fully established. 15 Sequential intervention may be too lengthy for the preoperative timeframe and the order in which to prioritise risk factors is unclear.…”

“…Surgical patients may be less motivated and confident in quitting preoperatively compared to other lifestyle risk factors. 13 Encouragingly, the preoperative setting remains an opportune moment to achieve cessation. 33 Measurable reductions in postoperative complications require 4-6 weeks preoperative cessation.…”

Perceived influences on smoking behaviour and perceptions of dentist‐delivered smoking cessation advice: A qualitative interview study

“…Recent research has identified that short-term health benefits were more influential for behaviour change than long-term benefits. 26 This provides further support for the dental setting being a teachable moment where short-term benefits can be seen.…”