Prehabilitation in Oesophageal Cancer Care: A Qualitative Study of What Moves Patients

Abstract

Background: Personalised interventions are recommended to optimise participation in prehabilitation programmes, but this requires insight into what motivates patients to participate in, and complete, such programmes. We investigated the experiences of patients with oesophageal cancer who had participated in a prehabilitation programme, with a view to identifying factors that contribute to programme participation. Methods: This multicentre, qualitative study included patients who had completed a curative trajectory of neoadjuvant chemoradiotherapy and surgery for oesophageal cancer and who had been offered a multimodal prehabilitation programme in the period between chemoradiotherapy and surgery. Prehabilitation consisted of nutritional support and a supervised physical training programme. Data were collected after surgery using semi-structured interviews. Data were analysed using an inductive thematic analysis. Results: Twelve patients were interviewed. Main themes contributing to programme participation were ‘development of internal motivation’, ‘external motivation through relational support’ and ‘programme feasibility and perceived benefits’. Factors related to internal motivation were ‘a clear purpose (to get through surgery)’, ‘patients’ sense of responsibility for treatment success’ and ‘a positive change of mind during the programme’. Factors related to external motivation included ‘support and supervision from healthcare providers’ and ‘support from family members’. The programme was feasible, but patients differed in their preferred level of dietary support and training supervision. Overall, the patients were positive about the programme, feeling that it prepared them for surgery. Conclusions: This study shows that patients with oesophageal cancer are motivated by internal and external factors to participate in a multimodal prehabilitation programme. Clear information on the purpose of the programme, tailored supervision by healthcare providers and active involvement of family members support this feasible form of prehabilitation care.