Overview
Based on a comprehensive assessment by a trained healthcare professional, individuals should be stratified into moderate- or high-risk categories.
Risk stratification informs the allocation of care, with moderate-risk individuals receiving targeted prehabilitation interventions and high-risk individuals receiving specialist psychological interventions.1
Modified from MacMillan Prehabilitation interventions triangle1
Targeted psychological intervention
Who can deliver it
Clinicians delivering targeted interventions need to have a baseline understanding of:
Targeted interventions can be delivered by healthcare professionals with additional training in psychological support or behaviour change such as:
- Psychologists
- Social workers
- Counsellors
- Clinical nurse specialists
- Occupational therapists
- Dietitians
- Physiotherapists
- Speech therapists
How – targeted psychological intervention
When individuals experience mild-moderate levels of mental health symptoms or prehabilitation psychological concerns, any targeted interventions should be delivered directly from the clinician via face-to-face, video-calls or phone calls and personalised to the individual with cancer2.
Direct personal education has been shown to reduce anxiety and improve skills/knowledge in psycho-oncology whereas universal education improves only skills/knowledge3.
Targeted prehabilitation interventions could include the following interventions:
Timing of intervention
The timing of psychological prehabilitation interventions should be based on clinical judgment of the needs of the individual. In the absence of specific guidelines on the optimal timing of prehabilitation psychological interventions, the following factors can be considered:
| Reasons for early psychological intervention | Reasons for later psychological intervention (closer to surgery date) |
| Allows enough time to support the individual’s behaviour change to engage in other prehabilitation interventions (e.g. exercise, nutrition). | Anxiety may increase closer to surgery and when more details about surgery are provided. |
| Allows enough time to address any potential severe mental health concerns. | The majority of research studies have delivered a single session of psychological prehabilitation one week prior to surgery +/- follow up post-surgery. |
| Allows enough time to address multiple psychological concerns that may arise with more complex surgeries (e.g. body image, sexual functioning concerns, significant quality of life impacts). |
On balance, services may decide to provide immediate psychological assessment following referral, with consideration of reassessment or pathways to re-engage should further concerns arise closer to surgery date or following surgery.
Frequency of reviews
There is currently no guideline as to the timing or frequency of reviews, as such the number and frequency should be based on clinical judgment.
Reviews may be considered useful in the 1-2 weeks before surgery when anxiety is likely to escalate, which is also consistent with the timing of psychological prehabilitation in much of the existing literature.
Services or clinicians may also consider reassessing needs and considering reviews at discharge from inpatient admission or shortly afterwards when adjustment and mood difficulties may arise.