Abstract / Summary
Abstract Background Prehabilitation for patients awaiting cancer surgery and/or treatment comprises support for exercise, nutrition, and emotional well-being. Prehabilitation is associated with faster recovery and improved outcomes. Practical action to improve inclusion in prehabilitation is needed to reduce inequities in cancer care and outcomes. This study explored cancer prehabilitation practices to understand how, when, and why people engage (or otherwise) with prehabilitation. Methods Ethnographic case study of cancer prehabilitation within seven National Health Service (NHS) Wales organisations (United Kingdom) that offered prehabilitation to adults with upper gastrointestinal, colorectal, lung, prostate, and/or breast cancer. Data were collected from observations of prehabilitation consultations and semi-structured interviews, using a sampling frame for a socioeconomically diverse patient sample. A focus group with cancer care workers took place at each NHS organisation. Qualitative data were analysed using a thematic framework approach. Results We observed prehabilitation consultations with 120 patients, 45 (37.5%) from the most socioeconomically deprived communities, and conducted 168 brief interviews with 32 cancer care workers and 36 in-depth patient interviews. Seven focus groups involved 44 cancer care workers. Patterns of modifiable factors for inclusive access to, acceptance of, and adherence to cancer prehabilitation are described within six themes: personal capacity for prehabilitation; closer alignment of patient, family, and health professional expectations; interpersonal connection and support; potholes and forks in the prehabilitation pathway; diversity of prehabilitation delivery; and person-centred prehabilitation. Conclusions For prehabilitation to be inclusive, each patient needs to understand how prehabilitation can help them as an individual (motivation and self-efficacy) through surgery and/or treatment for cancer. Health professionals and other cancer care workers should prioritise aligning expectations for prehabilitation. To achieve this, communication and delivery of prehabilitation education and services must be person-centred and involve interpersonal support.