Defining Criteria for Quality and Equity in Prehabilitation Services Before Cancer Surgery: A Delphi Study Informed by Lived and Professional Experience

Abstract

Background: Prehabilitation before cancer surgery has been recommended for implementation in clinical practice to improve patients’ functional and psychological wellbeing to improve outcomes. Currently, in the United Kingdom, cancer prehabilitation interventions vary in how and where they are offered, potentially widening health inequalities and little is known about patient preferences. This first of a kind study aimed to invite both people with lived experience of cancer and healthcare professionals to define a set of criteria for quality and equitable prehabilitation interventions for cancer treatment.

Methods: A modified Delphi technique was implemented over three rounds of online questionnaires with prehabilitation professionals (experts by profession, n = 8) and people with lived experience of cancer (experts by experience, n = 14) in the United Kingdom. The first round of criteria statements was developed in a series of co-design workshops. In each Delphi round, participants were asked to rank the statements on a 5-point Likert scale and make suggestions for refinement or additional statements. Consensus was defined as at least 75% of participants voting to indicate agreement on each statement.

Results: A total of 22 participants voted in Delphi questionnaire with a 76% response rate. 63.6% of participants were ‘experts by experience’ and 36.4% were ‘experts by profession’. The questionnaire started with 54 statements and through three rounds of voting, refinement and addition, 56 statements reached consensus. Over three rounds, six statements did not reach consensus. Criteria were grouped into seven themes: developing and delivering prehabilitation (covering prehabilitation definitions, safety and evaluation processes and interactions with patients), emotional health, nutritional, physical and multimodal interventions, integrating community-based care and addressing inequalities.

Conclusions: This is the first research to develop a set of criteria for evaluating and designing equitable prehabilitation before cancer surgery in the United Kingdom. The results will be of interest to researchers, healthcare professionals and service providers interested in designing, evaluating and delivering prehabilitation before cancer surgery.