P96 ‘Listen; the patient is speaking’: revealing the voice of patients awaiting liver transplants through co-designing a remote prehabilitation intervention

<h3>Introduction</h3> Liver disease can be overwhelming for patients. Adverse outcomes include early mortality, with other significant complications including adverse psychological, physical, and dietary outcomes.¹ Despite these challenges, few patients within the UK have access to prehabilitation.^{2 3} This study used Experience Based Co-Design (EBCD), a methodology where patients, caregivers, and clinicians work collaboratively. The aim was to co-design the content and the delivery method of a remote multicomponent prehabilitation intervention. <h3>Methods</h3> A purposive sample of patients, caregivers, and clinicians were included. Experiences were captured through focus groups and semi-structured interviews. The focus groups and semi-structured interviews identified ‘sub-experiences’ (specific experiences each person associates with a particular situation). A facilitated 3-hour workshop was delivered remotely in 2023. The workshop commenced with a 15-minute ‘scene-setter’ film portraying patient experiences, the content of which was informed by the focus groups and interviews. Following this, participants agreed on the sub-experiences identified and confirmed key priority areas for development in the intervention. Participants were allocated to 6 breakout rooms allowing in-depth discussions that developed each key priority area. The workshop concluded with a 45-minute feedback session, capturing key content details for the intervention. <h3>Results</h3> 19 patients (15 male; 8 pre-transplant; mean age (SD) 60 (7) years); 6 caregivers (1 male; 4 pre-transplant; mean age (SD) 56 (11) years), 13 clinicians (9 male;10 with hepatology experience; 9 with prehabilitation experience; mean age (SD) 37.5 (8) years) and 6 facilitators attended the workshop. Participants agreed on key priority sub-experiences for development into the intervention. Key priority areas included exercise ‘number one has to be exercise’, diet ‘there should be more support on the dietary front’, psychology ‘you need emotional support’, education (pre- and post-transplant) ‘there should be a booklet’, peer support ‘if they can just talk to people going through the same thing’ and social support ‘if there’s information that can be given to point people in the direction of, social support’. The workshops confirmed 1) the delivery format - a booklet, and online meetings, 2) the frequency - weekly exercise, diet, and emotional support sessions and monthly peer support sessions and 3) who should deliver the intervention - members of the liver transplant multidisciplinary team (MDT) should be delivering the intervention. <h3>Conclusion</h3> The workshop established the content and delivery method for the intervention. The next steps are to design and deliver a feasibility study to test the intervention. <h3>References</h3> Duarte-Rojo A, Ruiz-Margain A, Montano-Loza AJ, Macias-Rodriguez RU, Ferrando A, Kim WR. Exercise and physical activity for patients with end-stage liver disease: improving functional status and sarcopenia while on the transplant waiting list. <i>Liver Transpl</i>. 2018;<b>24</b>(1):122–39. Williams AM, Waits S, Englesbe MJ. The importance of prehabilitation in liver transplantation. <i>Current Transplantation Reports</i>. 2015;<b>2</b>(4):312–5. Williams FR, Vallance A, Faulkner T, Towey J, Durman S, Kyte D,<i> et al</i>. Home-based exercise in patients awaiting liver transplantation: a feasibility study. <i>Liver Transpl</i>. 2019;<b>25</b>(7):995–1006. Bate P, Robert G. Bringing user experience to healthcare improvement: the concepts, methods and practices of experience-based design. <i>Radcliffe Publishing.</i> 2007. Boyd H, McKernon S, Mullin B, Old A. Improving healthcare through the use of co-design.<i> N Z Med J</i>. 2012;<b>125</b>(1357):76–87.