Mr Rohan Miegel1,2, Prof David. I Watson1,2, Prof Raymond Chan2, Dr Matthew Wallen2, Dr Sarah Hunter2
1Flinders Medical Centre, Bedford Park, Australia, 2Flinders University, Bedford Park, Australia
Biography:
Rohan Miegel is a Senior Physiotherapist in Cancer Care at Flinders Medical Centre, SALHN, where he works with oncology and haematology patients. Rohan has over 10 years' experience as a Physiotherapist in several major hospitals in South Australia and the United Kingdom. He is currently undertaking a part-time PhD at Flinders University investigating perspectives regarding prehabilitation for cancer surgery. He has a strong passion for promoting allied health input early in the cancer care continuum and understanding how to implement this in the public health system.
Abstract:
Purpose:
Multimodal prehabilitation for cancer surgery is promising to improve patient outcomes. Many studies report issues with patient uptake and adherence as well as implementation into usual care. This systematic review aimed to investigate the key factors to barriers and facilitators to prehabilitation for cancer surgery, and to make recommendations utilising the iPARIHS implementation framework.
Methods:
MEDLINE, CINAHL, Scopus, PsycInfo were systematically searched for qualitative and mixed-methods studies published from January 2010 to August 2023. The iPARIHS framework was used to synthesis the data into innovation, recipient, and contextual implementation facilitators and barriers.
Results:
Thirty-seven studies were included. Major themes identified included information transfer, individual factors, relationships and operational factors. Innovation factors include health professional caution of the quality of evidence but acknowledging an evolving cancer care culture. Within the recipient construct, considerations to maximise implementation and participation included: providing a clear and individualised invitation to a customised and evidence-based program delivered in an acceptable method, active support and monitoring that is based in the patient-health professional relationship. Context based operational factors such as support (funding, resources, staff, time), service promotion, and streamlined clinical pathways were highlighted as sustainable strategies for implementation into usual care.
Conclusion:
This review used the iPARIHS framework to highlight implementation frequent barriers and facilitators to improve prehabilitation for cancer surgery acceptance and delivery. Leveraging the patient-health professional relationship to enable a transfer of perceived value should be facilitated by explicit health system promotion and support.