Table 4.
Identified barriers and facilitating factors classified based on the systematic assessment phase of OMRU1
| Category | Barriers | Facilitators |
|---|---|---|
| Innovation: prehabilitation | ||
| Relative advantage | Contradictory and low quality of scientific evidence for (cost-) effectiveness | Evidence regarding effectiveness of prehabilitation is important for program sustainability |
| Costs must be financed immediately while yields are not (directly) clear | Both objective as well as patient reported outcomes are important for program evaluation | |
| Uncertainty which group benefits (most) from prehabilitation | ||
| Indirect costs for patients (e.g., travel expenses) | ||
| Compatibility | Goal and content of prehabilitation program is unclear | Patients are able to improve their self-reliance instead of just waiting |
| Application of prehabilitation fits in hospital strategy | ||
| Complexity and reinvention | Differences in patients’ resilience and training opportunities | Individualized program |
| Observability | Effectiveness difficult to prove due to heterogeneity of patient population | |
| Quality of care for colorectal surgery is already high with low complication rates | ||
| Trialability | Adjust patient selection during implementation based on (local) results | |
| Practice environment: hospital | ||
| Physical structure | Combining appointments is difficult due to different work activities | Combining appointments on a single day |
| Operating room planning takes precedence over prehabilitation program | Accessible contact between involved healthcare professionals | |
| Lack of program organization evaluation | Preoperative multidisciplinary prehabilitation consultation | |
| Patients are unable to visit hospital frequently | Offering an intervention program close to home | |
| Implementation of digital tools for interaction and reduction of travel distance | ||
| Workload | Multidisciplinary consultation is time consuming | Evaluation of individual patients only in case of signaled problems or deviation from program |
| Counseling patients is time consuming | ||
| Available resources | Healthcare system is not adapted, including availability of paramedics in hospital | Coordination of program and program appointments by a specialized nurse |
| Guarantee financial support | ||
| Culture and believes | Time between operation indication and surgery is too short | Delay surgery if necessary |
| Introduce prehabilitation early in trajectory | ||
| Potential adopters: health care professionals and patients | ||
| Healthcare professionals | Healthcare professionals are unaware of (importance of) prehabilitation program | Include skeptical healthcare professionals in prehabilitation team from the adoption phase |
| Patients | The idea that sedentary behavior is necessary when cancer is diagnosed | Set goals and motivate patients to accomplish them |
| The idea that tumor should be removed as soon as possible | Introduce prehabilitation as part of regular care | |
| Insight in movement pattern | ||
| Awareness regarding impact of surgery on physical condition | ||
| Incorporate social environment to facilitate patient with prehabilitation program | ||
| Group activities to exchange experiences and motivate peers | ||
| Personal support during prehabilitation program | ||
| Transfer strategies: diffusion, dissemination and implementation of prehabilitation | ||
| Local champions | An ambassador should persuade, enthuse, and unite coworkers | |
1OMRU, Ottawa Model of Research Use (OMRU) framework. The framework proposes to study six key components: innovation; environment; adopters; strategies for transferring evidence into practice; the use of evidence; and health-related and other outcomes of the process. These components are connected to each other through the process of evaluation [23]. The framework guides assessment of potential barriers and facilitators to prehabilitation with regard to the innovation (prehabilitation), environment (hospital), adopters (health care professionals and patients), and also the strategies that interviewees identified for the implementation of prehabilitation