Prehabilitation in cancer care: patients' ability to prepare for major abdominal surgery

Background Patients' perspectives on standardised, multimodal prehabilitation programmes showed barriers to adherence. Further investigation of patients' ability to prepare is needed. Aim To investigate what patients with cancer who were due to undergo major abdominal surgery actually were able to do when provided with preoperative, home-based, multimodal recommendations presented in a leaflet. Methods Patients from the colorectal- or ovarian cancer centre, who were scheduled for major abdominal surgery, received a leaflet with preoperative recommendations. On a daily basis, the patients filled in what they had completed in relation to these recommendations, so that adherence could be investigated. Additionally, face-to-face interviews were conducted to evaluate patients' experiences of using the leaflet. Malterud's principles of systematic text condensation were used to analyse the interviews. A convergent design was used to merge the quantitative and qualitative data into a combined interpretation presented in the discussion. Results A total of 53 patients returned a completed leaflet, and five patients were interviewed. In the combined interpretation, patients' ability to prepare was presented through four major domains. The domains were adherence and the importance of support, manageable actions leading to change, preparation in a broader perspective and impediments to preparation and to symptom relief. Conclusions Patients prepared themselves in various ways, which were not limited to recommendations inspired by multimodal prehabilitation. Patients from the ovarian cancer centre increased their weekly exercise during the preoperative period, which indicates that the leaflet not only functioned as a data collection tool, but also motivated and supported the patients in prehabilitation-related actions. Patients' perspectives on prehabilitation need to be taken into account, when aiming to enhance patient-centredness and adherence.