Participation and Compliance in a Multimodal Prehabilitation Program for Colorectal Cancer (PACE): A Qualitative Study

Misha AT Sier,1,2 Maud PPJ Cox,1,3 Thaís TTT Tweed,4 Nick Servaas,1,3 Jan Willem M Greve,1,3 Jan HMB Stoot1 1Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands; 2School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands; 3Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands; 4Department of Surgery, Maastricht University Medical Center+, Maastricht, 6229 hX, The NetherlandsCorrespondence: Misha AT Sier, Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands, Tel +31-6-40953595, Email [email protected]: Interest in prehabilitation, the preoperative enhancement of patients’ condition, is rising in the surgical field. Challenging factors appear to be patients’ motivation to participate in and their compliance with prehabilitation programs. The aim of this qualitative study was to study the real-life experience of prehabilitation by assessing the lived experience and perceptions of participants in a multimodal prehabilitation program and to explore factors that influence participation and compliance during prehabilitation.Methods: Patients who underwent surgery for colorectal cancer and who had participated in the 4-week multimodal prehabilitation program “BEFORE” feasibility study were recruited. Their lived experiences were collected through semi-structured, individual, in-depth interviews. Interviews were transcribed verbatim and analyzed using a thematical approach. As no new information emerged after the interviews, data were considered saturated.Results: Six patients were interviewed. Seven main themes were discussed during the interviews, including information provision, motivation for participation, and content of the program. The results of this study emphasize the importance of adequate patient education, in-hospital exercise with the supervision of physiotherapists, and a patient-centered program. Logistical problems and the impact of cancer diagnosis were most frequently reported as barriers to participation.Conclusion: Participation could be improved by providing adequate information and solving logistical issues. Patient-centeredness of the program is an important feature in improving adherence.Keywords: participation, compliance, prehabilitation, colorectal surgery, colorectal cancer