Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study

Abstract

Background Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. Methods The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. Results A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. Conclusions This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.

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

“…This study was successful in enabling both experts by experience (people with lived experience of cancer) and experts by profession (professionals with a role in prehabilitation services) to create and reach consensus on the criteria based on values, objectives and aims for prehabilitation delivery and care. Previous Delphi studies on prehabilitation have focused mainly on the input of healthcare professionals with a role in prehabilitation (37,38), although the inclusion of patients in future studies has been strongly recommended (37). This study has produced criteria that include 60 statements organised within seven categories (Figs.…”

Prehabilitation: tertiary prevention matters

“…This is caused by heterogeneity in interventions, target patient groups, and outcome measures. The top three research priorities in prehabilitation listed in an international Delphi study were: the effects of prehabilitation on surgical outcomes; identifying populations most likely to benefit from prehabilitation; and the optimal composition of prehabilitation programmes 54 . Concerning the first priority, a core outcome set could be helpful 55 .…”

Current landscape and support for practical initiation of oncological prehabilitation translatable to thyroid cancer: A position paper

“…Therefore, conducting randomized clinical trials to generate prospective data firstly on the efficacy, which is yet to be proven in patients with DTC, and then effectiveness of prehabilitation in this patient cohort would provide the strongest evidence for the increased uptake and acceptance in the field. The need for clear research priorities to inform the design of future prehabilitation trials has been recognized in a recently published international Delphi study [ 126 ]. The top research priorities in prehabilitation for patients undergoing cancer surgery identified by a panel of prehabilitation experts included the effect of prehabilitation on surgical outcomes, identifying populations most likely to benefit from prehabilitation and optimal composition of prehabilitation programs [ 126 ].…”

“…The need for clear research priorities to inform the design of future prehabilitation trials has been recognized in a recently published international Delphi study [ 126 ]. The top research priorities in prehabilitation for patients undergoing cancer surgery identified by a panel of prehabilitation experts included the effect of prehabilitation on surgical outcomes, identifying populations most likely to benefit from prehabilitation and optimal composition of prehabilitation programs [ 126 ]. In the absence of randomized clinical trials, healthcare providers may consider establishing a small independent study using existing study protocols and practical tips from other researchers.…”