Skip to main content
SpringerLink
Log in

Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the autologous stem cell transplant population: a theory-based interview study

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Health care professionals (HCP) play a vital role in effectiveness of prehabilitation programs, but information is limited about what assists HCP deliver an effective service. This study evaluated HCP perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to autologous stem cell transplant.

Methods

Based on the Theoretical Domains Framework (TDF) of behaviour change, we conducted semi-structured interviews, purposively sampling 14 participants (from various healthcare disciplines) at a tertiary cancer centre. Discipline-specific topic guides were created based on the TDF and the behaviours appropriate to each discipline. Interviews were audio-recorded, transcribed verbatim, anonymised, content analysed (grouping, then labelling, thematically similar responses), and classified into theoretical domains. Structured decision rules were used to classify themes as high, medium, or low priority.

Results

Fifty enablers and 31 barriers were identified; of these 26 enablers and 16 barriers classified as high priority. Four domains had the most frequent high-priority enablers: Social professional role and identity (e.g. multidisciplinary teamwork); Beliefs about consequences (e.g. patient benefit); Memory, attention, and decision processes (e.g. refer as early as possible); and Environmental context and resources (e.g. electronic medical records are beneficial). High-priority barriers were most frequent in four domains: Memory, attention, and decision processes (e.g. conflicting views about who should be referred); Environmental context and resources (e.g. lack of time); Social influences (e.g. families); and Emotions (e.g. patient distress).

Conclusion

Participants reported more enablers than barriers. Findings can support delivery of prehabilitation programs in hospital settings where uptake remains low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cook G, Ashcroft AJ, Cairns DA, Williams CD, Brown JM, Cavenagh JD et al (2016) The effect of salvage autologous stem-cell transplantation on overall survival in patients with relapsed multiple myeloma (final results from BSBMT/UKMF Myeloma X Relapse [Intensive]): a randomised, open-label, phase 3 trial. Lancet Haematol 3(7):e340–e351

    Article  PubMed  Google Scholar 

  2. Lenhoff S, Hjorth M, Holmberg E, Turesson I, Westin J, Nielsen JL et al (2000) Impact on survival of high-dose therapy with autologous stem cell support in patients younger than 60 years with newly diagnosed multiple myeloma: a population-based study. Nordic Myeloma Study Group. Blood 95(1):7–11

    PubMed  CAS  Google Scholar 

  3. Attal M, Harousseau J-L, Stoppa A-M, Sotto J-J, Fuzibet J-G, Rossi J-F et al (1996) A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. N Engl J Med 335(2):91–97

    Article  PubMed  CAS  Google Scholar 

  4. Campagnaro E, Saliba R, Giralt S, Roden L, Mendoza F, Aleman A et al (2008) Symptom burden after autologous stem cell transplantation for multiple myeloma. Cancer 112(7):1617–1624

    Article  PubMed  Google Scholar 

  5. Chakraborty R, Hamilton BK, Hashmi SK, Kumar SK, Majhail NS (2018) Health-related quality of life after autologous stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 24(8):1546–1553

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wiskemann J, Huber G (2008) Physical exercise as adjuvant therapy for patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 41(4):321–329

    Article  PubMed  CAS  Google Scholar 

  7. Macmillan Cancer Support (2019) Prehabilitation for people with cancer Principles and guidance for prehabilitation within the management and support of people with cancer, vol 2020

  8. Wood WA, Phillips B, Smith-Ryan AE, Wilson D, Deal AM, Bailey C et al (2016) Personalized home-based interval exercise training may improve cardiorespiratory fitness in cancer patients preparing to undergo hematopoietic cell transplantation. Bone Marrow Transplant 51(7):967–972

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. van Haren I, Staal JB, Potting CM, Atsma F, Hoogeboom TJ, Blijlevens NMA et al (2018) Physical exercise prior to hematopoietic stem cell transplantation: a feasibility study. Physiother Theory Pract 34(10):747–756

    Article  PubMed  Google Scholar 

  10. Rupnik E, Skerget M, Sever M, Zupan IP, Ogrinec M, Ursic B et al (2020) Feasibility and safety of exercise training and nutritional support prior to haematopoietic stem cell transplantation in patients with haematologic malignancies. BMC Cancer 20(1):1142

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Mawson S, Keen C, Skilbeck J, Ross H, Smith L, Dixey J et al (2021) Feasibility and benefits of a structured prehabilitation programme prior to autologous stem cell transplantation (ASCT) in patients with myeloma; a prospective feasibility study. Physiotherapy 113:88–99

    Article  PubMed  PubMed Central  Google Scholar 

  12. Crowe J, Francis JJ, Edbrooke L, Loeliger J, Joyce T, Prickett C et al (2022) Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre. Support Care Cancer 30(2):1841–1852

    Article  PubMed  Google Scholar 

  13. van der Zanden V, van der Zaag-Loonen HJ, Paarlberg KM, Meijer WJ, Mourits MJE, van Munster BC (2021) PREsurgery thoughts - thoughts on prehabilitation in oncologic gynecologic surgery, a qualitative template analysis in older adults and their healthcare professionals. Disabil Rehabil 1–11. https://doi.org/10.1080/09638288.2021.1952319

  14. Waterland JL, Ismail H, Amin B, Granger CL, Denehy L, Riedel B (2021) Patient acceptance of prehabilitation for major surgery: an exploratory survey. Support Care Cancer 29(2):779–785

    Article  PubMed  Google Scholar 

  15. Provan D, McLean G, Moug SJ, Phillips I, Anderson AS (2022) Prehabilitation services for people diagnosed with cancer in Scotland - Current practice, barriers and challenges to implementation. Surgeon Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland 20(5):284–290. https://doi.org/10.1016/j.surge.2021.08.005

    Article  Google Scholar 

  16. Atkins L, Francis J, Islam R, O'Connor D, Patey A, Ivers N et al (2017) A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci 12(1):77

    Article  PubMed  PubMed Central  Google Scholar 

  17. Duncan EM, Francis JJ, Johnston M, Davey P, Maxwell S, McKay GA et al (2012) Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. Implement Sci 7:86

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cuthbertson BH, Campbell MK, MacLennan G, Duncan EM, Marshall AP, Wells EC et al (2013) Clinical stakeholders’ opinions on the use of selective decontamination of the digestive tract in critically ill patients in intensive care units: an international Delphi study. Crit Care 17(6):R266

    Article  PubMed  PubMed Central  Google Scholar 

  19. Patey AM, Islam R, Francis JJ, Bryson GL, Grimshaw JM, Canada PPT (2012) Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests. Implement Sci 7:52

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357

    Article  PubMed  Google Scholar 

  21. Presseau J, McCleary N, Lorencatto F, Patey AM, Grimshaw JM, Francis JJ (2019) Action, actor, context, target, time (AACTT): a framework for specifying behaviour. Implement Sci 14(1):102

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zoom Video Communications I (2022) Zoom video communications, Inc. (Version 5.0.1 [computer software]). Retrieved from https://zoom.us/

  23. Krippendorff K (2018) Content analysis: an introduction to its methodology. SAGE publications

    Google Scholar 

  24. QSR International Pty Ltd (2020) NVivo. Retrieved from https://www.qsrinternational.com/nvivo-qualitativedata-analysis-software/home

  25. Chapman O, Taylor RM (2021) Barriers and faciliators for healthcare professionals to implementing a prehabilitation programme: review of the literature. J Cancer Rehabil 4:86–90

    Google Scholar 

  26. Newton RU, Taaffe DR, Chambers SK, Spry N, Galvao DA (2018) Effective exercise interventions for patients and survivors of cancer should be supervised, targeted, and prescribed with referrals from oncologists and general physicians. J Clin Oncol 36(9):927–928

    Article  PubMed  Google Scholar 

  27. Mohammadi S, Reid H, Watson W, Crocker M, Robillard JM, Westby M et al (2021) A qualitative study on prehabilitation before total hip and knee arthroplasties: integration of patients’ and clinicians’ perspectives. Disabilities 1(4):361–376

    Article  Google Scholar 

  28. Chapman O, Taylor RM (2022) Exploring the barriers and facilitators for an upper gastrointestinal prehabilitation service. J Cancer Rehabil 5:56–61

    Google Scholar 

  29. Michie S, Johnston M, Francis J, Hardeman W, Eccles M (2008) From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol 57(4):660–680

    Article  Google Scholar 

  30. Agasi-Idenburg CS, Zuilen MK, Westerman MJ, Punt CJA, Aaronson NK, Stuiver MM (2020) “I am busy surviving” — views about physical exercise in older adults scheduled for colorectal cancer surgery. J Geriatr Oncol 11(3):444–450

    Article  PubMed  Google Scholar 

  31. Miller DT, Ross M (1975) Self-serving biases in the attribution of causality: fact or fiction? Psychol Bull 82(2):213–225

    Article  Google Scholar 

  32. Zuckerman M (1979) Attribution of success and failure revisited, or: The motivational bias is alive and well in attribution theory. J Pers 47(2):245–287

    Article  Google Scholar 

Download references

Data and code availability

The data used and/or analysed during the current study are available from the corresponding author on reasonable request.

Funding

Partial funding was provided by the Allied Health Department at the Peter MacCallum Cancer Centre for external transcription of the interviews. The funders played no role in the design, conduct, or reporting of this study.

Author information

Authors and Affiliations

  1. Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Jessica Crowe

  2. Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia

    Jessica Crowe, Lara Edbrooke & Linda Denehy

  3. Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Lara Edbrooke, Linda Denehy & Jill J. Francis

  4. Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia

    Amit Khot

  5. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia

    Amit Khot

  6. Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia

    Jill J. Francis

  7. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

    Jill J. Francis

Authors
  1. Jessica Crowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lara Edbrooke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit Khot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda Denehy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jill J. Francis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

J. F., L. D., L. E., A. K., and J. C. contributed to the design of the study, ethics application, development and refinement of topic guides, data analysis, and the structure of the manuscript. J. F., a health psychologist with extensive experience in semi-structured interviewing and the TDF, provided advice and guidance on topic guide development, training in TDF methods, and data analysis. J. C. completed this manuscript as part of her postgraduate research through the University of Melbourne and completed all data collection. J. C. is supervised by L. D., J. F., L. E., and A. K. All authors contributed to the manuscript writing and had final approval of the manuscript.

Corresponding author

Correspondence to Jessica Crowe.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Human Research Ethics Committee on 3 March 2021: REC/73444/PMCC.

Consent to participate

Verbal consent was obtained prior to the interview and audio-recorded by the researcher after the participant had reviewed the participant information documentation.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 68 kb)

ESM 2

(DOCX 24 kb)

ESM 3

(DOCX 39 kb)

ESM 4

(DOCX 17 kb)

ESM 5

(DOCX 36 kb)

ESM 6

(DOCX 28 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crowe, J., Edbrooke, L., Khot, A. et al. Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the autologous stem cell transplant population: a theory-based interview study. Support Care Cancer 32, 25 (2024). https://doi.org/10.1007/s00520-023-08234-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-08234-z

Keywords

Search

Navigation