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Motivation and behaviour change

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Multimodal prehabilitation is only successful when the individual with cancer chooses to engage in prehabilitation and to adhere to the recommended interventions1. Providing information alone is not sufficient to promote behaviour change1, and the strategies outlined in this section can be used to optimise engagement and behaviour change in all prehabilitation interventions.

Person-centred approach

It is recommended that prehabilitation interventions are designed with a person-centred approach to increase engagement by considering the needs and preferences of the individual with cancer1.

Factors to consider when individualising the individual's prehabilitation
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Understanding stages of change

For any new behaviour, it is important to consider how prepared the individual is to change their behaviour. You can review the below summary of the stages of behaviour change to determine how prepared they are to change and what actions are required of their healthcare professionals.

Figure 1: Stages of behaviour change

Barriers to engagement

  • Lack of understanding of the potential benefits of prehabilitation overall or benefits of one or more disciplines/interventions
  • Not prioritising prehabilitation over other commitments
  • Physical symptoms and comorbidities (e.g. nausea, fatigue, pain, shortness of breath)2-4
  • Lack of time, including due to the burden of multiple hospital appointments2-4
  • Limited financial capacity, including due to program costs such as gym memberships or supplements5
  • Lack of social support
  • Anxiety and stress or other emotional factors impacting engagement6.

Strategies

Realistic goal setting and action planning

Goals should be realistic and tailored to the individual, based on their current activity levels and personal circumstances1. To ensure a goal is realistic, clinicians can return to S.M.A.R.T. goal setting.

Clinicians could create action plans in line with SMART goals with the person with cancer to increase goal achievement. An example SMART goal template and action plan has been provided.

Clinicians can also assess how realistic a goal is by using the confidence ruler.

Self-monitoring

Individuals with cancer should be provided with a method to monitor their adherence to a treatment strategy or to monitor any relevant behaviours or use of intervention strategies1.

Prehabilitation clinicians can check the self-monitoring regularly to increase adherence.

Alternatively, clinicians could choose to use clinician-monitoring by implementing a weekly phone call that includes a standardised set of questions to monitor behaviours or use of intervention strategies7-10.

 

Examples of prehabilitation self-monitoring methods to record behaviours
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Enhancing autonomy and control

Individuals with cancer are more likely to engage in prehabilitation if they have a sense of self-efficacy, autonomy and control within the prescribed program1 . Some strategies to enhance autonomy and control include:

  • Offering individuals simple choices where possible1
  • Providing an opportunity to tailor their prehabilitation themselves, in accordance with their daily life and resources.

Increasing motivation

Strategies to enhance motivation can be used to promote behaviour change in prehabilitation1, drawing from motivational interviewing principles. All disciplines can use the following strategies with each intervention they deliver:

Graded tasks
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Importance ruler
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Confidence ruler
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Strengthen commitment to change
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For more information on motivating patients, strategies from this helpful resource for general practice setting can also be applied to prehabilitation.

Assessing self-efficacy

Self-efficacy describes the confidence of the individual with cancer in having the ability to achieve a particular goal and is a predictor of surgical outcomes(see 13). It is therefore recommended that all individuals undergoing prehabilitation are assessed for self-efficacy, to provide opportunity to problem-solve and improve self-efficacy to improve engagement in prehabilitation interventions.

Some possible measures of self-efficacy that can inform this assessment are listed below. (^Information correct as of date of toolkit publication).

Self-efficacy assessment measures

Cancer Behavior Inventory-Brief Version (CBI-B)
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Patient-Reported Outcome Measurement Information System (PROMIS) self-efficacy general
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General self-efficacy scale
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Smoking self-efficacy questionnaire
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Multidimensional Self-efficacy for Exercise Scale (MSES)
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Behavioural Regulation of Exercise Questionnaire 2 (BREQ-2)
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Tailored item
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Patient activation measure
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^Correct at time of publication 

Resources

Surgical patient optimisation passport SMART goals template
References
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On this page
Engaging people with cancer in prehabiliation Person-centred approach Understanding stages of change Barriers to engagement Strategies Assessing self-efficacy Resources
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Acknowledgements

Co-Principal Investigators:

  • A/Prof Alicia Martin – Director of Allied Health, Peter MacCallum Cancer Centre
  • Jenelle Loeliger – Manager Nutrition and Speech Pathology, Peter MacCallum Cancer Centre

Project Manager: ​

  • Dr Christina Prickett​ – Clinical Psychologist, Peter MacCallum Cancer Centre

Project team:​

  • Dr Rajib Ahmed​ – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Professor Linda Denehy​ – Head of Allied Health Research, Peter MacCallum Cancer Centre
  • Ben de Zoete – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre
  • Dr Lara Edbrooke – Allied Health Research Development Lead, Peter MacCallum Cancer Centre
  • Dr Maria Ftanou – Director of Psychosocial Oncology, Peter MacCallum Cancer Centre
  • A/Prof Hilmy Ismail – Anaesthetist, Peter MacCallum Cancer Centre
  • Professor Berhard Riedel​ – Director of Anaesthetics, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre
  • Catherine Sinton​ – Clinical Nurse Consultant, Peter MacCallum Cancer Centre
  • Anya Trail​l – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre

Communications Advisor:

  • Maddison Gray – Communications & Media Specialist, Western & Central Melbourne Integrated Cancer Services (WCMICS)

Clinical content leads: ​

  • Dr Raj Ahmed – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Anna Beaumont – Dietitian, Peter MacCallum Cancer Centre
  • Jess Crowe – Physiotherapist, Peter MacCallum Cancer Centre
  • Dr Fiona Lynch – Clinical Psychologist, Peter MacCallum Cancer Centre
  • Lisa Nguyen – Physiotherapist, Peter MacCallum Cancer Centre
  • Catherine Sinton – Clinical Nurse Consultant, Peter MacCallum Cancer Centre

Steering committee members:

  • Dr Rajib Ahmed​ – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Michael Barton – Deputy Manager, Western & Central Melbourne Integrated Cancer Services (WCMICS)
  • Hollie Bevans – Senior Dietitian, Western Health
  • Professor Linda Denehy​ – Head of Allied Health Research, Peter MacCallum Cancer Centre
  • Janelle Devereux and Bianca Bell – Executive Director, Health Systems Integration, North West Melbourne Primary Health Network (NWMPHN)
  • Ben de Zoete – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre
  • Dr Lara Edbrooke – Allied Health Research Development Lead, Peter MacCallum Cancer Centre
  • Dr Maria Ftanou​ – Director of Psychosocial Oncology, Peter MacCallum Cancer Centre
  • Mr Michael Hii – Deputy Director, HPB and Upper GI Surgery, St Vincent’s Hospital Melbourne
  • A/Prof Hilmy Ismail​ – Anaesthetist, Peter MacCallum Cancer Centre
  • Drew Kenneady – Consumer Representative
  • Mainak Majumdar – Director, Critical Care, Mercy Health
  • A/Prof Alicia Martin ​- Director of Allied Health, Peter MacCallum Cancer Centre
  • Sharyn McGowan – Allied Health Team Leader, Bendigo Health
  • Fiona McKinnon – Director of Allied Health, St Vincent’s Hospital Melbourne
  • Orla McNally – Surgeon, The Royal Women’s Hospital
  • Jenelle Loeliger – Manager Nutrition and Speech Pathology, Peter MacCallum Cancer Centre
  • Denise Mitchell – Consumer Representative
  • Kathryn Pierce – Western Health Allied Health Representative, Western Health
  • Amanda Piper – Head of Cancer Strategy, Cancer Council Victoria (CCV)
  • Dr Christina Prickett​ – Clinical Psychologist, Peter MacCallum Cancer Centre
  • Professor Berhard Riedel​ – Director of Anaesthetics, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre
  • Catherine Sinton​ – Clinical Nurse Consultant, Peter MacCallum Cancer Centre
  • Anya Trail​l – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre
  • Chris White – Director, Cancer Centre, Bendigo Health

Contributions to content:

  • Shaza Abo – Physiotherapist, Peter MacCallum Cancer Centre
  • Dr Diva Baggio – Haematology Laboratory Registrar, Peter MacCallum Cancer Centre
  • A/Prof Cherie Chiang – Endocrinologist & Internal Medicine Consultant Physician, Peter MacCallum Cancer Centre
  • Professor Linda Denehy​ – Head of Allied Health Research, Peter MacCallum Cancer Centre
  • Dr. Amy Dennett – Physiotherapist, La Trobe University
  • A/Prof Helena Frawley – Principal Research Fellow, Allied Health, University of Melbourne
  • Dr Margaret He – Consultant Anaesthetist, Tauranga Hospital, New Zealand
  • Dr Nicolette Holt – Respiratory, Sleep & Perioperative Consultant Physician, Peter MacCallum Cancer Centre
  • A/Prof Hilmy Ismail​ – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Ms Alana Jones – Enhanced Recovery after Surgery Nurse Coordinator, Royal Melbourne Hospital
  • Erin Laing – Dietitian, Peter MacCallum Cancer Centre
  • Dr Debra Leung – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Tennille Lewin – Centre for Health Services Research, Peter MacCallum Cancer Centre
  • Celia Marsten – Occupational Therapist, Peter MacCallum Cancer Centre
  • Dr Walston Martis – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Dr Mark Nolan – Consultant Cardiologist, Peter MacCallum Cancer Centre
  • Dr Chad Oughton – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Ella Sexton – Clinical Psychologist, Peter MacCallum Cancer Centre
  • Dr Emma Tyson – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • A/Prof David Westerman – Consultant Haematologist, Peter MacCallum Cancer Centre
  • A/Prof Jamie Young – Pain & Rehabilitation Consultant Physician, Peter MacCallum Cancer Centre

The project team sincerely thanks all participants from various stages of this project:

  • The consumers, health professionals and other experts who participated in the co-design workshops
  • The health professionals and patients from the three implementation sites including Western Health, Bendigo Health and St Vincents Hospital Melbourne.


Homepage illustration by pikisuperstar

Contact

For questions or comments related to this website, please email prehabtoolkit@petermac.org