Psychological Readiness for Surgery Through Prehabilitation and Treatment: A Longitudinal Qualitative Study

Psychological prehabilitation aims to prepare patients for cancer treatment, yet psychological readiness is under-specified and distress during and after treatment is common. A patient-informed account of readiness is needed to guide readiness-focused, proactive psychological support in cancer care.

To examine patients' experiences of psychological readiness for cancer surgery across the prehabilitation-treatment pathway.

We used a longitudinal qualitative design. Ten adults enroled in a tertiary cancer prehabilitation service for major elective surgery completed semi-structured interviews before surgery (T1) and after surgery (T2). We analysed data using Reflexive Thematic Analysis with an inductive, semantic approach, and compared change and stability across time points using a longitudinal analytic matrix.

Participants described psychological readiness as developing a future-focused "mindset to have surgery", comprising three interrelated elements that were stable from T1 to T2: confidence, motivation, and contained anxiety, that is, anxiety that remained expected and manageable rather than absent or overwhelming. Three processes shaped this mindset. Reliable and complete information from professionals and credible peers supported clearer and more concrete expectations, increased confidence, and helped keep anxiety manageable. Participants preferred candid information about plausible difficulties over reassurance that downplayed them. Reciprocal support from family, peers, and professionals strengthened motivation and reduced loneliness. Readiness could be held back when participants found it difficult to tell loved ones about their diagnosis. Agency developed through drawing on personal resources and taking controllable steps, including making progress visible through prehabilitation activity and staff encouragement.

These findings identify provisional, patient-informed targets for psychological preparation within multimodal prehabilitation. They provide a foundation to operationalise and measure readiness and, following work on transferability, co-production and feasibility, to test whether readiness-focused support in prehabilitation is associated with post-operative adjustment.