L'ACCEPTABILITÉ DE LA PRÉHABILITATION À L'EXERCICE AVANT LA RÉSECTION ONCOLOGIQUE : UNE APPROCHE À MÉTHODES MIXTES

E. Smith1, L. Brennan1, M. Sékhon2, J. Hussey1, E. Guinan3
1Trinity College Dublin, Physiothérapie, Dublin, Irlande, 2Kings College, Population Health Sciences, London, United Kingdom, 3Trinity College Dublin, School of Medicine, Dublin, Ireland

Contexte: Exercise prehabilitation aims to enhance patients before cancer surgery and is known to increase fitness, reduce post-operative complications and improve health related quality of life. However, for prehabilitation to work, patients must have access to an effective programme which is acceptable to all stakeholders. Acceptability is a ‘multi-faceted construct that reflects the extent to which people delivering or receiving an intervention consider it to be appropriate’. Acceptability across stakeholder groups is crucial in ensuring an intervention can be integrated into a pre-established clinical pathway. Therefore as services expand globally, the acceptability must be considered.

Objectif : To explore the acceptability of exercise prehabilitation before cancer surgery among key stakeholders including patients, family members and healthcare workers (HCW).

Méthodologie: Acceptability was assessed using a mixed-methods approach. An anonymous online 8-item Likert scale questionnaire based on work of Sekhon et al. (2017) was distributed and respondents were invited to attend semi-structured interviews to explore the concept further. Participants were recruited through social media, email and surgical oncology clinics in St James’ Hospital, Dublin. An overall acceptability score, calculated as a composite of the seven acceptability constructs (burden, affective attitude, ethicality, intervention coherence, self-efficacy, effectiveness, opportunity cost) and single-item general acceptability score is provided. A high correlation between the ‘general acceptability’ construct and any of the other constructs indicates areas of high acceptability.Descriptive statistics were conducted with SPSS V26. Qualitative data was analysed using reflexive thematic analysis.

Résultats: In total, n= 230 completed the questionnaire (n= 101 HCW, n=91 patients, n=34 family members and n= 4 undefined) with n=20 (n=13 HCW, n=5 patients and n=2 family members) completing interviews. Overall acceptability (max score 40) was comparable between stakeholder groups (29(4) (HCW), 29(7) patient and family members 28(4) (p=0.740)). Four constructs were positively correlated; affective attitude (rs=.513, p<0.001), ethicality (rs=0.348, p<0.001), self-efficacy (rs=0.404, p=<0.001), intervention coherence (rs=0.357, p<0.001).
Qualitative data revealed participants had positive feelings towards prehabilitation, citing psychological benefits including a sense of control. They felt a flexible prehabilitation program would be suitable for all patients and identified barriers and facilitators that should be considered to reduce patient burden. However, patients required more information on the topic and HCWs felt that resourcing difficulties and time limited appointments reduced the potential for discussions on prehabilitation.

Conclusions: Exercise prehabilitation is acceptable to key stakeholders. Though prehabilitation may be associated with some burden, it is perceived as a worthwhile and effective intervention that stakeholders like the idea of; understand its purpose; are confident in patients’ ability to participate and regard it is an important intervention contributing to patients’ psychological and physical wellbeing.

Implications This research shows that, in order to facilitate prehabilitation, the presentation and delivery of the service should be carefully designed to ensure a supportive and collaborative approach; programs should be patient focused and accessible for all; and the service must be appropriately resourced with a clear referral process. This is crucial information for physiotherapists, as prehabilitation services are rapidly being commissioned and developed globally.

Remerciements de financement : IRISH CANCER SOCIETY’ under the MRCG-HRB Joint Funding Scheme [MRCG-2018-17]

Mots clés:
Préhabilitation à l'exercice
Acceptability of healthcare intervention
Développement de services

Sujets:
Oncologie, VIH et soins palliatifs
Prestation de services / rôles émergents

Ce travail a-t-il nécessité une approbation éthique? Oui
Établissement : Trinity College Dublin
Comité : Comité d'éthique de la recherche de la Faculté des sciences de la santé
Numéro d'éthique : 210202

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