Priorities for prehabilitation for patients with upper gastrointestinal cancer: a nominal group consensus study

Prehabilitation is a broad and evolving concept that is recommended to improve patient outcomes but is not offered routinely to patients undergoing surgery in centres across the UK. The purpose of this study was to combine existing evidence with expert opinion to establish consensus on the key priorities for prehabilitation interventions in patients undergoing surgery for upper gastrointestinal cancer.

A modified nominal group technique was utilised. Prior to an online meeting, individual ideas were generated in response to questions across three themes: prehabilitation interventions, clinical implementation and behaviour change support, and outcomes and cost-effectiveness. The online meeting included facilitated discussions to clarify and regroup ideas, followed by anonymous ranking of individual ideas. GroupMap™ software was used to collect and analyse the data.

Eight individuals attended the meeting in November 2023, including physiotherapists and dietitians experienced in prehabilitation and an experienced patient advocate. A high level of consensus was achieved across many aspects of prehabilitation, with eight out of 89 ideas achieving 100% consensus agreement (9%) and 31 out of 89 ideas achieving consensus of 70% or higher (35%). The main findings demonstrated complete consensus that prehabilitation should be delivered as a multimodal, multidisciplinary intervention that combines all three core aspects (exercise, nutrition and psychological support).

The study findings are consistent with developing evidence trends and confirmed which core aspects should be incorporated into prehabilitation interventions for patients undergoing upper gastrointestinal surgery. These insights will help to develop prehabilitation services that are integrated across professions and systems for best patient care.