From Theory to Practice: An International Approach to Establishing Prehabilitation Programmes

June F Davis; Stefan J van Rooijen; Chloe Grimmett; Malcom A West; Anna M Campbell; Rashami Awasthi; Gerrit D Slooter; Michael P Grocott; Franco Carli; Sandy Jack

doi:10.1007/s40140-022-00516-2

From Theory to Practice: An International Approach to Establishing Prehabilitation Programmes

Curr Anesthesiol Rep. 2022;12(1):129-137. doi: 10.1007/s40140-022-00516-2. Epub 2022 Feb 18.

Authors

June F Davis^{1

2}, Stefan J van Rooijen³, Chloe Grimmett⁴, Malcom A West^{5

6

7

8}, Anna M Campbell⁹, Rashami Awasthi¹⁰, Gerrit D Slooter¹¹, Michael P Grocott^{12

13

14

15

16}, Franco Carli¹⁰, Sandy Jack^{6

12}

Affiliations

¹ Macmillan Cancer Support, 89, Albert Embankment, London SE1 7UQ Vauxhall, UK.
² Allied Health Solutions, Hadlow, Kent UK.
³ Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
⁴ School of Health Sciences, University of Southampton, Southampton, UK.
⁵ University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
⁶ Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University of Southampton, Southampton, UK.
⁸ Department of Surgery, St. Mark's Hospital, Middlesex, UK.
⁹ School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
¹⁰ Department of Anaesthesia, McGill University, Montreal General Hospital, Montreal, QC Canada.
¹¹ Maxima Medical Center, Veldhoven, The Netherlands.
¹² Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹³ Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁴ Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁵ GICU, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁶ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.

Abstract

Purpose: This article focuses on the following:The importance of prehabilitation in people with cancer and the known and hypothesised benefits.Exploration of the principles that can be used when developing services in the absence of a single accepted model of how these services could be established or configured.Description of approaches and learning in the development and implementation of prehabilitation across three different countries: Canada, the Netherlands and the United Kingdom, based on the authors' experiences and perspectives.

Recent findings: Practical tips and suggestions are shared by the authors to assist others when implementing prehabilitation programmes. These include experience from three different approaches with similar lessons.Important elements include the following: (i) starting with a small identified clinical group of patients to refine and test the delivery model and demonstrate proof of concept; (ii) systematic data collection with clearly identified target outcomes from the outset; (iii) collaboration with a wide range of stakeholders including those who will be designing, developing, delivering, funding and using the prehabilitation services; (iv) adapting the model to fit local situations; (v) project leaders who can bring together and motivate a team; (vi) recognition and acknowledgement of the value that each member of a diverse multidisciplinary team brings; (vii) involvement of the whole team in prehabilitation prescription including identification of patients' levels of risk through appropriate assessment and need-based interventions; (viii) persistence and determination in the development of the business case for sustainable funding; (ix) working with patients ambassadors to develop and advocate for the case for support; and (x) working closely with commissioners of healthcare.

Summary: Principles for the implementation of prehabilitation have been set out by sharing the experiences across three countries. These principles should be considered a framework for those wishing to design and develop prehabilitation services in their own areas to maximise success, effectiveness and sustainability.

Keywords: Business case; Cancer; Implementation; Multidisciplinary; Multimodal; Prehabilitation; Surgery; Team.

Publication types

Review