Patient Perspectives on Prostate Cancer Prehabilitation: A Qualitative Study Using the Behaviour Change Wheel to Investigate Barriers and Facilitators to Engagement

Cancer prehabilitation aims to improve outcomes by helping patients physically and mentally prepare for treatment. This qualitative study aimed to investigate barriers and facilitators to engaging in prostate cancer prehabilitation and create recommendations for designing interventions. Semi-structured interviews were used to explore perspectives on cancer prehabilitation among men diagnosed with prostate cancer in Alberta, Canada. Interviews were thematically analyzed to identify barriers and facilitators to engagement. Themes were mapped to the Behaviour Change Wheel (BCW) to create recommendations for intervention development. Thirty-four men diagnosed with prostate cancer completed interviews. Key facilitators to engaging in prehabilitation included opportunities for social connection, strategies to reduce treatment-related side effects, and support coping with the psychological impact of diagnosis. Barriers included competing care priorities, lack of familiarity with prehabilitation, logistical challenges, and stigmatized perceptions of help-seeking. To promote improved patient engagement, prehabilitation interventions should be initiated near diagnosis, offer personalized, goal-oriented interventions with multiple components, and have options for virtual participation to increase accessibility. These recommendations may help improve the uptake and impact of prehabilitation programming in prostate cancer care. Further research to identify evidence-based interventions for mitigating treatment-related side effects may help increase patient motivation to engage in cancer prehabilitation.