EAES Academy

Introduction:

Prehabilitation has been postulated as an effective preventive intervention to improve surgical outcomes, particularly for elderly patients with a relatively high risk of postoperative complications. Several studies have reported difficulties in recruiting patients to participate in prehabilitation programs and establishing optimal compliance. The aim of this study was to explore how participation and compliance can be improved in prehabilitation programs by systematic literature review and in-depth interviews with participants.
Methods:


This study consisted of a systematic review of the literature combined with qualitative research in the form of interviews with patients who have participated in a prehabilitation program. The PubMed, Cochrane Library and EMBASE databases were searched to identify articles reporting motivators or barriers for participation in and compliance to preoperative prehabilitation programs. Programs had to entail an exercise and/or nutritional intervention and a duration of ≥ 7 days. All patients participating in the prehabilitation program were eligible for participation. The primary endpoints were factors facilitating or affecting participation and compliance to prehabilitation programs.

Results:


Forty-five studies/articles, of different designs, involving 2734 patients were included. In total, 716 participants were included in the qualitative researches and 2018 patients participated in interventional studies. Six patients were interviewed, non-participating patients were asked for the main reason to decline. Participation and compliance were examined on five main themes; information provision; reasons for participation; physical exercise; nutrition; psychological intervention. The results of this study emphasize the importance of adequate patient education, in-hospital exercising with supervision and a patient-centered program. Most often, logistical problems, physical condition and impact of cancer diagnosis were reported as barriers for prehabilitation. To date, there remains a paucity of evidence for the optimal method to increase compliance to the nutritional and psychological interventions.

Conclusion:

Participation and compliance is affected by numerous factors. In order to increase participation and compliance, adequate information provision, a patient-centered program, and eliminating logistical barriers are important. Future studies will have to be conducted to assess the vision of patients that declined participation. In addition, the effectiveness of interventions to improve participation and compliance should be evaluated.