Table 8 Scenario illustrating influence of fidelity on implementability

Study title

Fidelity of an allied health prehabilitation service for haematologic patients receiving high dose chemotherapy in a large cancer centre.

Background

Cancer prehabilitation can reduce post-treatment complications, enhance functional capacity, and empower patients to withstand treatment stressors. As part of a larger study, we evaluated the fidelity of a multidisciplinary allied health (exercise, nutrition, and psychology) prehabilitation clinical service as part of routine care in haematologic cancer patients receiving intensive conditioning chemotherapy prior to an autologous stem cell transplant (AuSCT).

Method

We retrospectively analysed data routinely collected from patients referred between March 2019 and March 2020. All patients considered for AuSCT at a tertiary specialist cancer centre were eligible to participate. The prehabilitation intervention included individualised exercise prescription and input from other allied health teams. Fidelity of the prescribed exercise program was assessed along the pathway from referral to the AuSCT service through to receipt by patients.

Results

183 patients were referred to the AuSCT service, 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Fidelity of exercise prescription was moderate with 72% of patients receiving the intended aerobic and resistance exercise intervention. Hence, 83 (65%) of the original 128 eligible patients actually received the exercise component of the intervention.

Conclusion

Although the prehabilitation service was well adopted by clinicians, there was some room for improvement in terms of the objective of providing all eligible patients with exercise prehabilitation support.

Relationship to implementability

1. Only two-thirds of eligible patients received the intervention as intended.

2. Although the intervention appears to be implementable, further support is needed to increase consistency and equity of delivery.

Reference

Crowe, J., Francis, J. J., Edbrooke, L., et al. Impact of an allied health prehabilitation service for haematologic patients receiving high dose chemotherapy in a large cancer centre. Under review.