Patient perspectives of multimodal prehabilitation for ovarian cancer with surgical intent: a multicentre qualitative evaluation of acceptability, barriers and facilitators for participation

Objective
To carry out a qualitative evaluation of personalised, multimodal prehabilitation for patients with advanced ovarian cancer in the UK, to inform the design and implementation of future programmes worldwide.

Methods
A multicentre, qualitative exploration of patients with advanced (stage III–IV) ovarian cancer with a surgical intent to treatment, who had been referred to a UK National Health Service prehabilitation programme. Using a purposive, maximum variation sampling approach, patients were invited to complete a semi-structured interview about their views and experiences of multimodal prehabilitation (exercise, nutritional, psychological and medical optimisation interventions). The interview focused on acceptability, perceived usefulness of the service and barriers and facilitators to engagement and adherence. Interviews were conducted virtually. Audio recordings of interviews were transcribed verbatim. Data were analysed thematically.

Results
Interviews were completed with 21 patients, with a median age of 56.5 years (range 37–89 years). Four main themes were identified with associated subthemes as follows: (1) introduction to the programme (timing, volume and content of information), (2) perceived need (support system and mindset, psychological and physical health), (3) delivery of the programme (convenience of appointments, accessibility of staff, family involvement, individual components of the intervention; ie, physical, psychological, nutritional interventions and group work) and (4) future engagement (addressing postsurgical gynaecological health and closure).

Conclusion
Overall, prehabilitation was acceptable to patients with advanced ovarian cancer who had been referred to a multimodal prehabilitation programme. Perceived accessibility of staff and inclusion of patients’ social network facilitated engagement. Lack of perceived need for prehabilitation was a barrier to participation, particularly for those with a strong support system or self-confessed strong physical and psychological baseline fitness. Effective patient-centred communication about prehabilitation could support patients with making informed choices about engagement in prehabilitation as part of their care plan.