To effectively develop a prehabilitation program, your service will need to define:
- What will be offered to patients in your setting
- Who is involved
- How often care will be provided
- Where care will take place
- What equipment and facilities are required.
What is being offered
Essential clinical components
See What is prehabilitation and Model of care sections for definitions and essential components of a prehabilitation program.
Who is involved
Resources and staffing appropriate to your setting will need to be allocated.
Staffing requirements and definitions
All clinicians may be involved in the following activities:
- Attending prehabilitation steering committee meetings
- Attending prehabilitation multidisciplinary team meetings
- Facilitating behaviour change aimed at gaining each individual’s adherence and compliance with the interventions.
All allied health disciplines (physiotherapists, dietitians, psychologists) may be involved in the following activities:
- Triaging discipline referrals, including clinical decision making for appropriateness of referrals, and risk stratification to determine appropriate intervention level for each discipline
- Delivering clinical care: completing assessment, coordinating and delivering interventions and educating people with cancer with ongoing modification of interventions as required
- Educating the broader treating or prehabilitation teams regarding the interpretation of discipline specific assessments (e.g. the psychologist might help the team understand the individual’s contributing psychosocial factors and their motivators to inform multidisciplinary treatment approaches)
- Providing expert advice regarding evaluation of discipline specific intervention and outcomes or research activities.
Table 1 below summarises the essential clinical roles and responsibilities within a cancer prehabilitation service.
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What if my service doesn’t have these disciplines
A range of health professionals with relevant discipline expertise in oncology may be involved in different components of the prehabilitation program. It is acknowledged that not all services will have access to the above disciplines so the following table provides a summary of the different professions that can provide various aspects of the prehabilitation program so that services can adapt the model to their own operational needs and limitations.
Figure 1 below summarises the different professionals that can deliver the various components of a cancer prehabilitation service.
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Additional roles
In keeping with a landmark paper published by Julie Silver1, multimodal prehabilitation may mean different things for different services.
While there are a range of clinical professionals that can deliver essential components of the prehabilitation service (e.g. exercise, nutrition, psychology), there are also additional components of prehabilitation services that may be implemented alongside the essential components depending on setting, resourcing and patient group.
The following expanding boxes summarise a range of disciplines that have been involved or integrated into prehabilitation services in Australia and internationally. This list is not exhaustive but is designed to serve as an example of how a prehabilitation service can be expanded or adapted to specific service needs.
Frequency
Information and evidence pertaining to interventions and the frequency of support is outlined in the Clinical delivery section of the toolkit for each relevant discipline.
Where it is delivered
Prehabilitation can be delivered face to face, by telehealth (video and/or phone) and in different settings such as hospital outpatients or in the home or community. Individuals with cancer preference and program settings including geography should be considered when deciding on a delivery approach to enhance program adherence. Several studies have identified these enablers/barriers to consider when deciding upon a setting2:
- Individuals with cancer preference
- Family support
- Travel and parking
- Session timing
- Health professional recommendations.
Supervision of delivery
Prehabilitation, as with many interventions, is shown to be more effective with supervision rather than being delivered in an unsupervised setting (such as home-based). To enhance efficacy of prehabilitation, adherence to the program is important3. The fidelity of the intervention (did the individual receive and act upon the intervention/information) is also important to support prehabilitation efficacy. These delivery methods should be considered and measured in any program2, for example but not limited to, program diaries, pedometer and heart rate monitoring wearable technology.
What facilities and equipment are required
Facilities
- It is essential for a cancer prehabilitation program to have access to dedicated space for clinical assessments to occur, that are accessible for patients who may have mobility impacted by their disease and/or treatment side-effects.
- Access to telephone and telehealth (video) facilities will also be essential depending on mode of delivery, and can offer greater choice to patients when available.
- Access to a corridor or level walking area will be necessary for exercise assessments, as will access to a gym (or similar facility) for individual and group exercise sessions.