I-Prehab
Inclusive prehab (I-Prehab) to address inequity in cancer outcomes: mixed-methods evaluation research to enhance access, acceptance and adherence
Chief Investigator: Prof Shea Palmer
Joint Lead Applicant: Prof Jane Hopkinson
Start date: April 2023
End date: March 2026
Award: £1,246,183.76
Funded by: NIHR Health and Social Care Delivery Research Programme
The I-Prehab study was developed by Prof Jane Hopkinson, working together with the NIHR Cancer and Nutrition Collaboration’s ‘Nutritional Care in People Living With and Beyond Cancer’ work stream.
Research question
What is the current prehabilitation (prehab) offer to patients with upper gastrointestinal, colorectal, lung, prostate, or breast cancer and what modifiable factors affect access to, acceptance of and adherence to prehab in patients from socially deprived communities at higher risk of poor treatment outcomes?
Background
Prehab aims to optimise cancer treatment outcomes through support for physical activity, nutrition and emotional resilience. It can reduce morbidity and mortality [1] with associated cost and bed savings [2]. People who are physically active, well-nourished and emotionally resilient experience less treatment toxicity, fewer treatment complications and live longer [1, 3-5]. People from socially deprived communities and some minority ethnic groups are underserved in prehab services[1,6].
Aim
To better understand access to, acceptance of and adherence to cancer prehab in socially deprived communities. This new knowledge will be used to devise I-Prehab, which will include an education toolkit and resources for cancer workers enabling them to support prehab for everyone, inclusive prehab.
Objectives
Objective 1. To conduct a systematic literature review to investigate what is known about access to, acceptance of, and adherence to prehab for patients with any cancer.
Objective 2. To conduct case study research to explore multiple stakeholder perspectives of access to, acceptance of, and adherence to cancer prehab.
Objective 3. To coproduce I-Prehab to facilitate engagement of people from socially deprived communities in prehab.
Objective 4. To evaluate the feasibility of delivering I-Prehab and to investigate patient experience of and cancer worker knowledge and confidence in inclusive prehab.
Methods
The project will use mixed-methods and work will be in partnership with patients and members of the public. It will be delivered as four interrelated work packages each producing novel insights.
Work Package 1: a systematic review to inform a conceptual model of access and adherence, that will be the framework for our empirical data collection and analysis.
Work Package 2: observational mapping study informing refinement of the framework and qualitative modelling yielding theoretical propositions about enablement of inclusive prehab.
Work Package 3: coproduction of I-Prehab through a prioritisation exercise, development of prototype and resources, then stakeholder workshops to refine for delivery.
Work Package 4: a feasibility study to evaluate method for delivery of I-Prehab and associated costs. Data analysis will enable us to meet our study objectives and synthesis of findings will answer our research question.
Timelines for delivery
Apr 2023 Dec 2023: Study set up; research permissions; systematic review
Jul 2023 Sept 2024: Case study research to map and qualitatively model prehab
Oct 2024 Mar 2025: Coproduction of I-Prehab
Apr 2025 Mar 2026: I-Prehab feasibility study; dissemination; submit final report.
Anticipated impact and dissemination
Impact will be through education of the cancer workforce in culturally appropriate prehab. Our dissemination plan will use I-Prehab to raise awareness of inclusive cancer prehab. We will publish findings in scientific and professional journals. Patients, the public and our partner organisations will work with us, for example on social media, to share I-Prehab within Wales and beyond.
Read the research protocol at https://fundingawards.nihr.ac.uk/award/NIHR151668