Identifying quality and inequality in prehabilitation services before cancer surgery: a Delphi study informed by lived and professional experience

Wareing, Laura, Hirst, Yasemin orcid iconORCID: 0000-0002-0167-9428, Shelton, Cliff, Gaffney, Christopher, Partridge, Andrea, Rycroft-Malone, Jo, Smith, Andrew and Ashmore, Lisa (2024) Identifying quality and inequality in prehabilitation services before cancer surgery: a Delphi study informed by lived and professional experience. BMC Health Services Research . (Submitted)

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Preoperative cancer prehabilitation interventions have been described as the practice of enhancing a patient’s functional capacity before surgery, aiming to improve postoperative outcomes. Internationally, it is increasingly recommended for implementation in clinical practice to improve patients’ functional and psychological wellbeing before cancer surgery. There is a gap in evidence on how and where it is delivered, what patients want from interventions and how inequalities in access and resources are addressed. In this study, both people with lived experience of cancer and healthcare professionals created criteria for quality and equitable preoperative cancer prehabilitation.


A modified Delphi technique was implemented over three rounds of online questionnaires with prehabilitation professionals (experts by profession) and people with lived experience of cancer (experts by experience). The criteria statements included in the first round of the questionnaire were suggested and 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. The consensus rate was defined as at least 75% of participants voting to indicate agreement on each statement.


A total of 22 participants voted in Delphi questionnaire with a 76% response rate. 63.6% of the participants were ‘experts by experience’ and 36.4% were ‘experts by profession’. The questionnaire started with 54 statements and 60 statements reached consensus. The criteria cover seven themes including developing and delivering prehabilitation, (covering prehabilitation definitions, safety and evaluation processes and interactions with patients), emotional health, nutritional, physical and multi-modal interventions, integrating community-based care and addressing inequalities.


To the authors’ knowledge, this is the first study that has developed criteria to guide the evaluation and design of prehabilitation interventions before cancer surgery with an emphasis on addressing inequalities, which have been developed by both experts by experience and profession.

The criteria enhance the evidence base on patient and healthcare professional preferences for quality and equitable access to prehabilitation interventions. The results will be of interest to researchers, healthcare professionals and service providers interested in designing, evaluating and delivering prehabilitation before cancer surgery.

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