Prehabilitation – what patients and carers want researchers to know


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Natalie Harris, Emma Nicholls, Conor McKeown, Bryn Thomas, Clare Shaw

Abstract

Background

Optimisation of physical and emotional health before and during cancer treatment (prehabilitation) has been shown to improve outcomes.  Questions remain on how best to design and deliver services that support people to achieve their maximum potential.  Patient co-design is important help to shape future research questions, design interventions and influence reported outcomes.  

Method

Approval was granted to recruit patients and the public to attend two focus groups. Any interested members of the public and cancer patients were eligible.  Participants were recruited through prehabilitation clinics, via PPI representatives and social media. 

 The two sessions, each of 2 hours duration, were conducted by a patient advocate with support from staff.  21 people attended.

The groups were asked to reflect on and share their beliefs regarding good practice and barriers to implementing key pillars of prehabilitation to help form research priorities in this area.  Participant comments were captured on flipchart paper and a visual minute taker created posters providing a pictorial representation to enable thematic analysis. Facilitators wrote down any additional comments voiced by participants and time was given for free discussion.

Results

Participants were able to identify the key components of a healthy lifestyle, however, they voiced that prehabilitation during cancer treatment was a challenge due to

  • Physical changes in health
  • Lack of confidence and self efficacy
  • Fear around the safety of exercise 
  • Conflicting information around lifestyle and cancer
  • Lack of clarity around potential benefits of lifestyle change

Enablers to support prehabilitation were

  • Clear messaging on the benefits
  • Peer and carer support
  • Personalisation of goals and monitoring
  • A non clinical setting
  • Techniques to improve self efficacy
  • Trusted and accessible resources

Research questions generated included

  • Exercise - how much is enough?
  • What is the long-term benefit of making a lifestyle change?
  • Can prehabilitation improve outcomes for BAME and other hard to reach groups?
  • How can big data be used to answer these research questions?

Pictorial representation of the focus group discussions will be presented in the posters.

Conclusion

Patients and public were able to share valuable insights and generate important research questions.

Impact statement

The results of this PPI work can be used in future protocol and service development