Open Access Open Access  Restricted Access Subscription Access

From waiting to preparing: A qualitative feasibility study of cancer patients’ perspectives on prehabilitation

Anne Beck, Henriette Vind Thaysen, Charlotte Hasselholt Soegaard, Jan Blaakaer, Lene Seibaek


Background: The aim of the study was to investigate cancer patients’ perspectives on a pre-defined, home-based, multimodal prehabilitation programme with particular attention to feasibility and acceptability.

Patients and methods: Fifteen patients with peritoneal carcinomatosis of colorectal or ovarian origin undergoing complete cytoreductive surgery (CRS), with or without hyperthermic intraperitoneal chemotherapy (HIPEC), participated in semi-structured interviews. Malterud’s principles of systematic text condensation were used to analyse the data.

Results: Patients had a positive attitude towards home-based prehabilitation, primarily because of the opportunity to influence recovery, but also because it could distract their attention from negative thoughts and because they could gain support. However, they would not follow the programme unconditionally and significant barriers to adherence were identified. These included lack of belief, everyday life, preferences and restrictions.

Conclusion: Patients’ perspectives on home-based prehabilitation contribute new knowledge concerning barriers to adherence to a programme. The findings underscore the complexity of developing a home-based, multimodal prehabilitation programme that not only enhances functional capacity, but is also experienced relevant to the patients and aligns with the demands of their everyday lives.


Adherence, cancer rehabilitation, existential care, functional capacity, holistic engagement, patient-centeredness, patient involvement, patient perspectives, person-centered care, prehabilitation, preoperative care, psychosocial support, qualitative rese

Full Text:



Wilson, R.J.T., Davies, S., Yates, D., Redman, J. & Stone, M. (2010). Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. British Journal of Anaesthesia 105 (3) 297-303.

Carli, F. & Scheede-Bergdahl, C. (2015). Prehabilitation to enhance perioperative care. Anesthesiology Clinics 33 (1) 17-33.

Carli, F., Gillis, C. & Scheede-Bergdahl, C. (2017). Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncologica 56 (2) 128-133.

Carli, F. & Ferreira, V. (2018). Prehabilitation: A new area of integration between geriatricians, anesthesiologists, and exercise therapists. Aging Clinical and Experimental Research 30 (3) 241-244.

Levett, D.Z., Edwards, M., Grocott, M. & Mythen, M. (2016). Preparing the patient for surgery to improve outcomes. Best Practice & Research: Clinical Anaesthesiology 30 (2) 145-157.

Silver, J.K., Baima, J. & Mayer, R.S. (2013). Impairment-driven cancer rehabilitation: An essential component of quality care and survivorship. CA: A Cancer Journal for Clinicians 63 (5) 295-317.

Bolshinsky, V., Li, M.H., Ismail, H., Burbury, K., Riedel, B. & Heriot, A. (2018). Multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery: A systematic review. Diseases of the Colon & Rectum 61 (1) 124-138.

Luther, A., Gabriel, J., Watson, R.P. & Francis, N.K. (2018). The impact of total body prehabilitation on post-operative outcomes after major abdominal surgery: A systematic review. World Journal of Surgery 42 (9) 2781-2791.

Hijazi, Y., Gondal, U. & Aziz, O. (2017). A systematic review of prehabilitation programs in abdominal cancer surgery. International Journal of Surgery 39, 156-162.

Carli, F., Charlebois, P., Stein, B., Feldman, L., Zavorsky, G., Kim, D.J., Scott, S. & Mayo, N.E. (2010). Randomized clinical trial of prehabilitation in colorectal surgery. British Journal of Surgery 97 (8) 1187-1197.

Chen, B.P., Awasthi, R., Sweet, S.N., Minnella, E.M., Bergdahl, A., Santa Mina, D., Carli, F. & Scheede-Bergdahl, C. (2017). Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Supportive Care in Cancer 25 (1) 33-40.

Gillis, C., Li, C., Lee, L., Awasthi, R., Augustin, B., Gamsa, A., Liberman, A.S., Stein, B., Charlebois, P., Feldman, L.S. & Carli, F. (2014). Prehabilitation versus rehabilitation: A randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121 (5) 937-947.

Li, C., Carli, F., Lee, L., Charlebois, P., Stein, B., Liberman, A.S., Kaneva, P., Augustin, B., Wongyingsinn, M., Gamsa, A., Kim, D.J., Vassiliou, M.C. & Feldman, L.S. (2013). Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: A pilot study. Surgical Endoscopy 27 (4) 1072-1082.

Minnella, E.M., Bousquet-Dion, G., Awasthi, R., Scheede-Bergdahl, C. & Carli, F. (2017). Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: A five-year research experience. Acta Oncologica 56 (2) 295-300.

Weber, T., Roitman, M. & Link, K.H. (2012). Current status of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Clinical Colorectal Cancer 11 (3) 167-176.

Awasthi, R., Minnella, E.M., Ferreira, V., Ramanakumar, A.V., Scheede-Bergdahl, C. & Carli, F. (2018). Supervised exercise training with multimodal pre-habilitation leads to earlier functional recovery following colorectal cancer resection. Acta Anaesthesiologia Scandinavica 63 (4) 461-467.

Robinson, J.H., Callister, L.C., Berry, J.A. & Dearing, K.A. (2008). Patient-centered care and adherence: Definitions and applications to improve outcomes. Journal of the American Academy of Nurse Practitioners 20 (12) 600-607.

Sutton, J. & Austin, Z. (2015). Qualitative research: Data collection, analysis, and management. Canadian Journal of Hospital Pharmacy 68 (3) 226-231.

Malterud, K., Siersma, V.D. & Guassora, A.D. (2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research 26 (13) 1753-1760.

Malterud, K. (2012). Systematic text condensation: A strategy for qualitative analysis. Scandinavian Journal of Public Health 40 (8) 795-805.

Ahmad, N., Ellins, J., Krelle, H. & Lawrie, M. (2014). Person-centered care: From ideas to action - bringing together the evidence on shared decision making and self-management support. The health foundation inspiring improvement. Available at:

Seibaek, L., Hounsgaard, L. & Hvidt, N.C. (2013). Secular, spiritual, and religious existential concerns of women with ovarian cancer during final diagnostics and start of treatment. Evidence-Based Complementary and Alternative Medicine doi: 10.1155/2013/765419.

Jensen, B.T., Laustsen, S., Jensen, J.B., Borre, M. & Petersen, A.K. (2016). Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways - secondary results from a randomized controlled trial. Supportive Care in Cancer 24 (8) 3325-3331.

Ferreira, V., Agnithotram, R.V., Bergdahl, A., van Rooijen, S.J., Awasthi, R., Carli, F. & Scheede-Bergdahl, C. (2018). Maximizing patient adherence to prehabilitation: What do the patients say? Supportive Care in Cancer 26 (8) 2717-2723.

Midtgaard, J., Hammer, N.M., Andersen, C., Larsen, A., Bruun, D. & Jarden, M. (2015). Cancer survivors' experience of exercise-based cancer rehabilitation - a meta-synthesis of qualitative research. Acta Oncologica 54 (5) 609-617.

Costelloe, T.M. (1996). Between the subject and sociology: Alfred Schutz's phenomenology of the life-world. Human Studies 19 (3) 247-266.

Moseholm, E., Rydahl-Hansen, S., Lindhardt, B.Ø. & Fetters, M.D. (2016). Health-related quality of life in patients with serious non-specific symptoms undergoing evaluation for possible cancer and their experience during the process: A mixed methods study. Quality of Life Research 26 (4) 993-1006.

Brett, J., Staniszewska, S., Mockford, C., Herron-Marx, S., Hughes, J., Tysall, C. & Suleman, R. (2014). Mapping the impact of patient and public involvement on health and social care research: A systematic review. Health Expectations 17 (5) 637-650.

Richards, D. (2015). The complex interventions framework. In: Complex Interventions in Health - an Overview of Research Methods. Richards, D. & Hallberg, I., (Eds.), pp. 1-15. London: Taylor & Francis Ltd.

Richards, D. (2015). Introduction to section 2 (investigating feasibility and undertaking pilot testing of complex interventions). In: Complex Interventions in Health - an Overview of Research Methods. Richards, D. & Hallberg, I. (Eds.). pp. 123-126. London: Taylor & Francis Ltd.

Malterud, K. (2017). Kvalitative forskningsmetoder for medisin og helsefag. 4. utgave. p. 254. Oslo: Universitetsforlaget. (In Norwegian).



  • There are currently no refbacks.