Prehab Acceptability V1
Research type
Research Study
Full title
Prehabilitation for Cancer: Understanding Views on Acceptability
IRAS ID
286264
Contact name
Rachael Powell
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
0 years, 5 months, 15 days
Research summary
Research Summary
People who are more physically active before surgery and other cancer treatments have better post-treatment outcomes than those who are less active. As a result, there is rapidly increasing interest and literature on prehabilitation interventions. Prehabilitation programmes are being developed and implemented to help people to become more physically active, and fitter, before undergoing cancer surgery, in order to optimise their recovery.However, for such programmes to be effective, they need to be acceptable to patients so that patients are willing and able to engage with them. The scientific literature shows that factors influencing acceptability of physical activity interventions are different for different populations (e.g. younger versus older adults), and it is possible that, for individuals who are about to undergo surgery and other cancer treatments, specific factors need to be considered when designing and implementing prehabilitation physical activity interventions. Despite the increasing literature on prehabilitation, little research has been conducted to understand the acceptability of such interventions. We will use the Greater Manchester (GM) Cancer Prehab4Cancer and Recovery Programme (Prehab4Cancer Programme) as an exemplar service to understand how patients perceive prehabilitation programmes, and what factors influence acceptability and engagement.
We will conduct qualitative interviews with individuals who have been offered the prehabilitation programme, to learn about how they perceive and experience it, and to understand what the barriers and facilitators to participating are. We will also use online survey technology to understand health professionals’ experiences of referring patients, and their perceptions of barriers and facilitators to patients engaging with prehabilitation.
Findings will be published in scientific journals to inform the development and implementation of prehabilitation programmes both nationally and internationally, and will inform the wider literature on physical activity intervention acceptability. Our findings will also be shared with local programme developers to optimise acceptability and access to prehabilitation services.
Summary of Results
Background Individuals who are more physically active before cancer treatments such as surgery have better post-treatment outcomes than those who are less active. Prehabilitation programmes aim to help people to become more physically active, and fitter, before cancer treatment, in order to help them to recover as well, and as quickly, as possible. The Greater Manchester Cancer Prehab4Cancer and Recovery Programme (the Prehab4Cancer Programme) aims to support physical activity for people before, during, and following cancer treatment. Patients’ fitness is assessed and a suitable exercise programme is created for them. Free gym membership is provided. Face-to-face support was stopped during Covid-19 lockdown periods and replaced with remote provision, for example, by providing on-line exercise classes to people in their own homes.
This study addressed the following research questions:
• How do patients undergoing surgery for cancer perceive prehabilitation?
• What are the experiences of health professionals involved in referring patients to prehabilitation?
Interviews were conducted with patient participants who had been referred to the Prehab4Cancer Programme. Clinician participants completed an online questionnaire.Patient sample
Eighteen patient participants took part in an interview: nine men and nine women, with ages ranging from in the 40s to 80s. Sixteen had participated in the Prehab4Cancer Programme; two had not. Fifteen interviews were conducted by phone; three by zoom. Interviews lasted between 29 and 99 minutes (median: 43 minutes).Clinician sample
Twenty-five participants completed the online survey; twenty-four of these were included in the analysis (one did not meet study inclusion criteria). The sample included nurses specialised in cancer or other specialisms, doctors with various specialities, and other NHS roles.
Study findings and interpretationThe Prehab4Cancer programme was clearly highly valued by both patients who took part and clinicians. High praise and gratitude were expressed. Patient participants reported feeling physically stronger and fitter, and many felt that they recovered better from surgery because they had taken part in the Prehab4Cancer Programme. Clinician participants also perceived improved patient fitness, and better recovery after surgery, as benefits of patients taking part in the programme. Patient participants also perceived psychological benefits to taking part in the programme. Formal psychological support was available to individuals through the programme, but it seems that individuals particularly valued implicit aspects of psychological support, such as feeling cared for by instructors before and after their surgery, and being able to talk with instructors. Having regular exercise sessions seemed to help people to feel better mentally as well as physically. The sessions appeared to provide a positive focus for people and enabled individuals to feel as prepared as possible for surgery. Individuals who took part in the Prehab4Cancer programme provided highly positive feedback about their instructors, and seemed to particularly appreciate the way that the programme was tailored to individual abilities and needs, ensuring that whilst they were exercising at a level to improve their fitness, they were able to take things at their own pace, and exercise within individual capacities. Individuals seemed to value having instructors who ensured that they were exercising safely, within the limits of health conditions and treatments. Participants felt supported by the instructors’ approach.
A key factor motivating participation in the Prehab4Cancer programme appeared to be the desire for patients to do what they could to be fit for their operation and to enhance their recovery. Having time to take part, and transport and/or a local gym may also be important. Those who took part in the programme seemed to have few commitments impacting their ability to take part, whereas from the responses of clinicians and a patient who declined taking part, commitments such as work, caring responsibilities and multiple hospital appointments may have made taking part in prehabilitation more difficult. Many of the participants who took part in the Prehab4Cancer Programme had access to a car and/or were able to attend sessions at a gym close to home; it was noted by both patient and clinician participants that lack of transport could make attending Prehab4Cancer sessions challenging, and some of those who did take part seemed to prefer locations close to home to minimise travel. During lockdown, whilst some individuals missed going to the gym, for others, remote provision, and being able to exercise in their own home, seemed to improve accessibility.
A challenge for both clinicians and patients seemed to be the timing of prehabilitation. Prolonged participation in an exercise programme yields greater benefit for the patient, so it is valuable to start exercising as early as possible. However, at the time of cancer diagnosis, there is a lot of information for staff to deliver and for patients to take on board. Patient participants seemed to find the Prehab4Cancer information leaflet of appropriate length for the point of referral to the programme, and were happy to learn more later, e.g. when they met with their instructor. For clinicians, covering the Prehab4Cancer programme alongside everything else of importance at the time of diagnosis could be challenging, and there was a risk that there might be insufficient time to mention the programme, or that staff could forget. Nevertheless, strategies were used to address missed contact, such as contacting the patient after the initial diagnostic discussions.
REC name
Wales REC 4
REC reference
20/WA/0237
Date of REC Opinion
8 Sep 2020
REC opinion
Favourable Opinion