Psychological, social, and behavioral barriers and facilitators to prehabilitation before cancer surgery: a qualitative systematic review

Background Prehabilitation before cancer surgery improves postoperative outcomes, yet patient participation remains suboptimal. This qualitative systematic review aimed to synthesize psychological, social, and behavioral barriers and facilitators to preoperative prehabilitation among adult cancer patients. Methods A systematic search was conducted in CNKI, Wanfang Data, CBM, VIP, PubMed, Web of Science, The Cochrane Library, Embase, and CINAHL from inception to January 13, 2025, with an updated search on May 31, 2025. A total of 1,184 articles were screened, and 20 qualitative studies were included. Quality appraisal was performed using the Critical Appraisal Skills Programme (CASP). Thematic analysis was employed for data synthesis. Results The analysis identified 7 facilitating factors: (1) Introduction Mechanisms, (2) Value Recognition, (3) Support Systems, (4) Communication Strategies, (5) Motivation and Feedback Mechanisms, (6) Program Design Optimization, and (7) Process Convenience and Program Accessibility, and 4 barrier factors: (1) Cognitive and Informational Barriers, (2) Individual Factors, (3) Clinical Process Limitations, and (4) Implementation Environment Barriers. When mapped onto a psychological, social, and behavioral framework, psychological facilitators included regained sense of control, mood regulation, and altruistic motivation; psychological barriers encompassed fear, low self-efficacy, and illness-related distress. Social facilitators comprised family involvement, peer support, and professional encouragement; social barriers included insufficient family support and communication gaps. Behavioral facilitators were driven by immediate progress feedback and self-monitoring; behavioral barriers included scheduling conflicts and low exercise confidence. Conclusion This synthesis reveals a persistent “cognitive-behavioral gap”—patients recognize the value of prehabilitation yet encounter barriers that prevent them from translating this recognition into sustained action. Addressing this gap requires integrated, multi-level strategies that enhance self-efficacy, mobilize social support, embed behavioral reinforcement mechanisms, and address systemic barriers. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420250650240.