Cancer prehabilitation in Scotland: 2025 survey findings report
This report summarises the findings from a survey of stakeholders and service providers about cancer prehabilitation and rehabilitation services in Scotland as of 2025.
5. Prehabilitation findings
Attitudes and awareness
This section presents attitudes among all survey respondents about the importance of prehabilitation; and their awareness of the ‘Key Principles’ for cancer prehabilitation.
Importance of prehabilitation
Respondents were asked about the importance of prehabilitation interventions for people about to undergo cancer treatment. 292 out of 302 potential respondents (97% of the sample) answered this question, with findings shown in Table 2.
| Importance of prehabilitation | Number of responses | % of responses to this question |
|---|---|---|
| 1 = Not important at all | 0 | 0% |
| 2 | 3 | 1% |
| 3 | 27 | 9% |
| 4 | 87 | 30% |
| 5 = Crucial | 175 | 60% |
| Total responses to this question | 292 | 100% |
Of those who answered the question, 90% attached high importance to prehabilitation (selected 4 or 5). 60% of those respondents rated it as ‘crucial’, similar to the equivalent 2022 findings (58%). There was slight variation between Cancer Network Areas. Prehabilitation was most likely to be rated as ‘crucial’ by SCAN (63%), followed by WoSCAN (60%) and NCA (54%) respondents.
Awareness of the ‘Key Principles for Implementing Cancer Prehabilitation in Scotland’
Respondents were asked to rate their awareness of the ‘Key Principles’, published in April 2022. 299 out of 302 respondents answered this question, of which:
- 41% selected 4 or 5 (high awareness)
- 21% selected 3 (medium awareness)
- 38% selected 2 or 1 (low awareness or not aware at all).
These figures are unchanged from 2022 findings. There was limited variation between Cancer Networks, with 43% reporting high awareness (selecting 4 or 5) in WoSCAN, 40% in SCAN and 38% in NCA.
Service availability and resourcing
This section considers the availability of local prehabilitation services, changes to services in the last 18 months, and plans to introduce new prehabilitation services. It also considers the issues of staffing and funding.
Availability of local prehabilitation activities
Respondents were asked whether any cancer prehabilitation activities were being offered in their local area. All 302 respondents answered this question. Half (50%) indicated that prehabilitation activities were offered in their local area, as shown in Table 3, which is consistent with that reported in 2022 (51%). Just over one third (36%) did not know, which is also in line with 2022 results (34%).
| Prehabilitation activities offered in local area? | Number of responses | % of responses to this question |
|---|---|---|
| Yes | 152 | 50% |
| No | 40 | 13% |
| Don't know | 110 | 36% |
| Total responses to this question | 302 | 100% |
A breakdown by Cancer Network for those who provided this information (n = 299) is shown in Table 4. As in previous years, WoSCAN respondents were more likely to report local activities than the other networks. SCAN shows the biggest increase (numerical and percentage) in respondents reporting local activities since 2022. Due to sampling limitations, caution should be exercised in interpreting this slight variation in the number reporting activities being offered in their networks.
| Number reporting that local prehabilitation activities were available, by Cancer Network | |||
|---|---|---|---|
| Cancer Network | 2019 | 2022 | 2025 |
| NCA | 6 | 23 | 33 |
| SCAN | 23 | 19 | 53 |
| WoSCAN | 49 | 53 | 64 |
| Total responses to this question | 78 | 95 | 150 |
Respondents with locally available prehabilitation services (n = 152) were asked further questions about the availability and resourcing of those services.
Changes in the last 18 months
In 2022, respondents were asked about changes to local prehabilitation activities since the onset of the COVID-19 pandemic. From this, it was found that there was an initial scaling back of many prehabilitation activities, followed by a resumption of them in blended or hybrid mode (including telephone or video service delivery). The 2025 survey included a similar question covering the past 18 months (i.e. since Autumn 2023) to track change over time. 115 out of a potential 152 responded.
Responses in 2025 presented a mixed picture. Many respondents mentioned time-limited or pilot projects coming to an end and the need for investment to provide long-term services. Some referenced scaling back activities due to changes to funding or staff resource. Several mentioned local prehabilitation activities having ceased in the last 18 months or having moved from interventions for specific cancer types to a more universal offering. However, there were also many examples of new or expanded services provided, some of which were supported by temporary funding. These included but were not limited to:
- Expanding local prehabilitation to include people with a wider range of cancer types
- New digital services
- Expanded from trial to a substantive prehabilitation service
- A new formal pathway for cancer prehabilitation
- New courses and interventions for people with cancer
- New promotional materials developed
- Pilot of screening tools
- Undertaking a test of change
- New Clinical Exercise Physiologist role.
A few respondents commented that improved local understanding of prehabilitation among staff has led to more referrals. This suggests that, despite limited statistical evidence of change in awareness about prehabilitation, there has been a shift in a few local areas and the instrumental effect of this on practice.
Delivery mode
As in 2022, respondents described the changing modes of delivering prehabilitation services, particularly now being able to offer phone and video support options. These developments were related to increased accessibility for people living in remote and rural areas. They were also seen as beneficial to teams working in one place yet covering a large area. However, it was acknowledged that these modes are not appropriate to everyone, and digital exclusion can act as barrier for some, underscoring the importance of co-designing services and offering choice.
Responses indicated that changes were not always towards greater digitisation. One respondent mentioned a Digital Prehab app, which had ceased after funding ended. Another described now having greater capacity for face-to-face support, from what was primarily telephone support. This highlights the ongoing funding that sustainable digital solutions require, as well as the continued value of in-person interactions in prehabilitation.
Staffing
Respondents were asked what staff or volunteers were involved in the delivery of prehabilitation activities in their local area. 150 out of 152 potential respondents answered this, with their responses shown in Table 5.
| Staff / Volunteer role (Select all that apply) | % of respondents selecting this role 2022 (n = 90) | % of respondents selecting this role 2025 (n = 150) |
|---|---|---|
| Nurse | 61% | 51% |
| Dietitian | 51% | 50% |
| Physiotherapist | 47% | 35% |
| Clinical Psychologist | 32% | 11% |
| Fitness Instructor (Local Authority/Move More etc.) | 28% | 23% |
| Occupational Therapist | 20% | 7% |
| Volunteer/Buddy/Peer Supporter | 19% | 19% |
| Counsellor | 13% | 8% |
| NHS Technical Instructor/Support Worker | 8% | 4% |
| Don’t Know | 7% | 19% |
Nurses, Dietitians, and Physiotherapists were the staff roles most likely to be identified by respondents as involved in the delivery of activities.
Compared with 2022, there were decreases in the proportions of respondents selecting:
- Clinical Psychologist (from 32% in 2022 to 11% in 2025)
- Occupational Therapist (from 20% in 2022 to 7% in 2025)
- NHS Technical Instructor/ Support Worker (from 8% to 4% in 2025).
There were also decreases in the proportions (albeit smaller) selecting Counsellors, Physiotherapists, Nurses and Fitness Instructors compared to 2022. Alongside this, more respondents selected ‘Don’t Know’. Maggie’s Centre staff and Speech and Language Therapists were the most frequently mentioned roles in ‘Other’. Palliative Care Consultants, Radiographers and Third Sector staff were also referenced by a few respondents.
Variability in results to this question across 2019, 2022, and 2025 surveys suggests that comparisons may reflect the sample of professionals who responded and their awareness of available services, rather than actual changes in service delivery. It is worth noting that more respondents here referred to prehabilitation (n=41) than provided prehabilitation services (n=20), which may explain some of the uncertainty about the specific staff composition following referral.
Involvement of staff delivering all three prehabilitation modes was reported by 9% of respondents with local prehabilitation activities, as shown in Table 6. This is a decrease from 19% in 2022 and appears to be driven by fewer respondents selecting physical fitness (17% reduction) and psychological support (26% reduction) roles compared to 2022. Open text responses highlighted two cases where psychological/emotional support has ceased in the last 18 months. However, no general pattern emerged of a decline in physical fitness roles in open text responses. Further follow-up conversations would be useful here to understand a full picture of workforce composition and change over time.
| Prehabilitation modes | % of respondents selecting this role (n = 150) |
|---|---|
| Physical Fitness: Physiotherapist and/or Fitness Instructor | 49% |
| Nutrition: Dietitian | 50% |
| Psychological Support: Clinical Psychologist and/or Counsellor | 17% |
| Responses showing staff from all 3 modes | 9% |
Qualitative responses from open text questions identified insecure funding for staff as a major theme, as discussed in Funding below. One respondent described undertaking a visit to another clinic to give insight into the prehabilitation team they would ideally like to build with additional funding. Respondents emphasised the importance of dedicated funding to support staff to deliver a full complement of prehabilitation modes, specific specialist staff to fill gaps in their local area, and to ensure staff capacity beyond ad hoc delivery. This suggests a strong and common concern around staffing and service sustainability, as well as individual areas sharing learning about how to scale up prehabilitation activities.
Funding
Respondents were asked what type of funding their prehabilitation activities received. 146 out of 152 for whom this question applied responded. Respondents could select multiple options and were invited to provide additional details about temporary funding. Nine respondents selected more than one type of funding category, and these were coded to the most appropriate response category. Where ‘temporary funding’ was selected alongside ‘no funding’, this was coded as ‘temporary funding’, and when ‘permanent funding’ was selected alongside ‘temporary funding’ this was coded as ‘permanent funding’ to show the presence of at least some of this type of funding. This suggests that the funding situation is complex, and the categories outlined in Table 7 describe the funding of some but not all prehabilitation activities locally.
| Types of funding | Number of responses | % of responses to this question |
|---|---|---|
| Permanent funding | 20 | 14% |
| Temporary funding | 39 | 27% |
| I don't know about funding | 63 | 43% |
| No funding | 19 | 13% |
| Other | 5 | 3% |
| Total responses to this question | 146 | 100% |
Compared to the 2022 survey, a greater proportion of respondents selected permanent funding in 2025 (14%, up from 2%). This figure is more closely aligned with that reported in 2019 (16%). Some respondents added that permanent funding in their area applies only to specific cancers or types of service, rather than all prehabilitation activities. For example, one respondent described permanent funding for rehabilitation services, temporary funding for prehabilitation sessions, and local leisure services that are self-funded by the patient/participant.
The proportion of respondents selecting temporary funding decreased from 39% in 2022 to 27% in 2025. Respondents expanded that in many cases temporary funding had stopped, was stopping later this year, or they were unsure of the end date. In ‘Other’, respondents noted that their prehabilitation service was offered within an existing permanently funded rehabilitation service. In 2025, over two fifths (43%) were unsure about the type of funding in their local area, and 13% described no funding, which is similar to responses in these categories in 2022.
The data above suggest that there has been fluctuation around the funding of prehabilitation activities over the past six years, as well as uncertainty and possible variations in respondents’ interpretations of terms ‘permanent’ or ‘temporary’. In 2025, a greater proportion of respondents selecting permanent funding compared to 2022 may indicate that prehabilitation is being integrated into services, even if this applies to specific cancer or treatment types, rather than all people with cancer, as respondents highlighted. Further insights from follow-up conversations with staff would be helpful to understand these reported changes given the lack of a clear picture and the need for caution when comparing responses across years due to the differences in the sample of staff respondents.
As in 2019 and 2022, funding and resources, including staffing, were strong interrelated themes in response to open text questions in the 2025 survey. Respondents discussed the need for dedicated and permanent funding to develop sustainable prehabilitation services. Several respondents discussed the need for permanent funding to extend pilots and continue offering prehabilitation. Respondents noted that funding for staff could enable earlier intervention or allow prehabilitation services to be offered to those preparing for any cancer treatment.
Additionally, a few respondents acknowledged the cost of offering prehabilitation services and noted that if prehabilitation activities are provided or expanded, these must displace something else. Further follow up would be helpful here to understand the resource allocation trade-offs that local areas face and whether any learning can be shared around how to provide continuity of care as pilot projects come to an end.
Introduction of new prehabilitation activities
All survey respondents were asked about plans to introduce or add to local prehabilitation activities. A quarter of those who responded (25%) indicated there were plans to introduce new activities, however the majority (64%) were unsure. These proportions are similar to 2022 survey results. Details are shown in Table 8.
| Plans to introduce / add to local activities? | Number of responses | % of responses to this question |
|---|---|---|
| Yes | 73 | 25% |
| No | 33 | 11% |
| Don't know | 185 | 64% |
| Total responses to this question | 291 | 100% |
There was some variation across Cancer Networks. In 2025, SCAN respondents were most likely to be aware of plans to introduce or add to local activities (32%), compared to WoSCAN (22%) and NCA (21%). In 2022, SCAN respondents were the least likely to be aware of plans to introduce or add activities. This may indicate that prehabilitation activity has increased since 2022 in this Cancer Network.
Service delivery and pathways
Respondents with locally available prehabilitation services reflected on prehabilitation service delivery and where improvement could enhance the effectiveness of local services.
Local delivery underpinned by ‘Key Principles for Implementing Cancer Prehabilitation’
Respondents were presented with a series of statements about the eight ‘Key Principles’ and asked to what extent they agreed that each principle underpinned the delivery of prehabilitation activities in their local area. For each statement, 151 or 152 out of 152 potential respondents answered the question.
The highest level of agreement was with the statement that “Prehabilitation activities are multi-modal including exercise/activity, nutrition and psychological support”, with 69% of respondents agreeing (including strong agreement). This finding showed an increase in positive responses since the 2022 survey (61%).
Over half of respondents in 2025 agreed with the three statements below, with levels of agreement higher than those reported in 2022 for each statement:
- “Prehabilitation activities run in parallel with usual decision-making processes so it does not have an adverse effect on cancer waiting times nor delay the start of treatment” (66% agreed, up from 55%).
- “Prehabilitation activities start as early as possible and in advance of any cancer treatment” (64% agreed, up from 46%).
- “Prehabilitation activities are part of the rehabilitation continuum” (64% agreed, up from 45%).
The increase in proportion of respondents agreeing with the above statements suggests stronger alignment with, and adoption of, those specific Key Principles of prehabilitation implementation in local delivery, compared to 2022 respondents.
Just under half of respondents (46%) in 2025 agreed that “Completion of prehabilitation screening should be recorded at cancer multidisciplinary team meetings alongside performance status”, similar to 2022 (47%).
Although higher than the previous survey, the following three statements received less agreement than others regarding implementation:
- “Validated tools are used for individualised assessment, care planning and outcomes measurement when patients are receiving targeted and specialist interventions” (34% agreed, up from 16%).
- “All patients are screened to determine the level of prehabilitation required (universal, targeted, specialist)” (32% agreed, up from 23%).
- “All patients (receiving universal, targeted and specialist interventions) have a co-produced personalised prehabilitation care plan” (26% agreed, up from 21%).
Lower levels of agreement for these statements suggests that screening for appropriate level of intervention, the use of validated tools with patients receiving targeted or specialist interventions, and co-produced personalised care plans could be considered as areas of ongoing action to support prehabilitation activities. It may also reflect gains in the use of validated tools for assessment, care planning and outcomes measurement compared to the previous survey in 2022.
Referrals
Respondents were asked if they personally referred people to prehabilitation activities, and how routinely they did so. 146 out of 152 potential respondents answered, with a breakdown of responses in Table 9.
| Referral to prehabilitation activities? | Number of responses | % of responses to this question |
|---|---|---|
| Yes | 61 | 42% |
| No | 55 | 38% |
| I provide prehabilitation services | 30 | 21% |
| Total responses to this question | 146 | 100% |
63% of respondents in 2025 reported that they either referred to or provided prehabilitation services, a figure broadly consistent with 60% reported in 2022.
All 61 respondents (those who answered Yes) answered the follow-up question about how routinely they refer people.
- 57% selected 4 or 5 (more likely to or always refer)
- 34% selected 3 (medium likelihood of referring)
- 8% selected 1 or 2 (less likely to refer).
Compared to 2022, the proportion reporting greater routineness of referral in 2025 (selecting 4 or 5) increased from 41% to 57%. Meanwhile, the proportion reporting a lower likelihood to refer (selecting 1 or 2) declined from 21% to 8%. This implies a positive development towards embedding prehabilitation into the patient pathway. However, it should be noted that the sample of respondents to this question for both years is smaller compared to the overall survey sample, which means there is less certainty in the extent of the magnitude of this change over time.
On the other hand, low referral numbers were raised by a few in response to open text questions, with these respondents feeling that this contributed to low service uptake. Comments highlighted the need to encourage staff to refer to services, raise awareness of the benefits of prehabilitation, and be mindful of patient burden in scheduling appointments. The challenge of referrals taking place across large geographical areas was also noted, along with the importance of having local services and staff familiar with them.
Timeliness of referrals remained a key theme from 2022. There was general agreement that prehabilitation should be started at the first suspicion or diagnosis of cancer to prepare patients for treatment. In addition, that prehabilitation should not delay first definitive treatment. In some areas, prehabilitation services were integrated in patient pathways, with staff routinely screening and referring or signposting people to appropriate services. Others, however, felt that this was not happening in their area, that the burden for staff of referring to multiple support systems was time consuming, or that in some cases people were starting prehabilitation too late to benefit fully from interventions and improve their clinical state.
When asked how local pathways could be improved to support prehabilitation, three common ideas emerged: dedicated funding for staff involved in prehabilitation, greater multi-disciplinary team (MDT) involvement, and better coordination of care.
Regarding coordination, respondents described investigating automated referrals to avoid any delays in starting prehabilitation, while others highlighted the benefit of a prehabilitation coordinator role. A coordinator or single point of contact was described as someone to work closely with the MDT to identify, screen, triage and refer. This role, already available in some areas, was seen to have potential to reduce the administrative burden, improve collaboration and the timeliness of referrals. In addition, a few respondents mentioned using temporary funding to establish or explore the development of prehabilitation clinics, aiming to create a more connected and coordinated service.
Screening, assessment and care planning
Respondents were asked if their local prehabilitation service was screening or triaging patients for perceived risk associated with each of the three modes of intervention. Of the 152 respondents with local prehabilitation activities, 144 to 145 answered questions about their modes of screening or triaging patients for perceived risk.
Around two thirds (66%) reported that their service screened for at least one mode, as shown in Table 10. The most reported mode of screening was for perceived nutritional risk. This contrasts with previous survey results where the proportions reporting screening were similar across all three modes. As mentioned above, due to sampling limitations, caution should be exercised when comparing responses between years given the differences in the sample of staff respondents.
| Screening or triaging patients for perceived risk associated with: | % reporting screening/triaging in 2022 | % reporting screening/triaging in 2025 |
|---|---|---|
| Nutrition | 44% | 53% |
| Physical Activity / Exercise | 46% | 38% |
| Psychological Need | 43% | 32% |
| Any mode | 71% (n = 67 respondents) | 66% (n = 96 respondents) |
| None of the modes | 29% (n = 28 respondents) | 33% (n = 48 respondents) |
A breakdown of the 96 respondents whose service was screening for any of the three modes is shown in Table 11. While overall the proportion screening for one or more modes in 2025 is similar to 2022, the proportion screening for all three is lower (29%, down from 50%), and screening for one mode was the most common response. These data may suggest that screening or triaging to determine what level of intervention is required is more consistent across Scotland for some modes of prehabilitation (nutrition) than others (physical activity or psychological need). A lower level of psychological screening reported here compared to other modes is supported by a few open text references to an absence of psychological support services to refer to, or a universal support offered. However, no clear pattern emerged in open text responses of one mode that was consistently lacking. As noted above, findings may reflect a different occupational profile of respondents between years and their awareness of practice and should therefore be interpreted with caution. Follow-up conversations with staff are recommended for more conclusive insights.
| Service screening for: | Number of respondents | % of total | % of respondents with a local service |
|---|---|---|---|
| all 3 modes | 28 | 29% | 19% |
| 2 modes | 26 | 27% | 18% |
| 1 mode | 42 | 44% | 29% |
| Total responses to this question | 96 | 100% | 66% |
Respondents whose service undertook screening were invited to describe how they were doing this; they responded as follows.
Nutrition: Tools such as the Malnutrition Universal Screening Tool (MUST) and Patient-Generated Subjective Global Assessment (PG-SGA) were commonly described. In some cases, different tools were used for different cancer types due to perceived variation in their sensitivity. Other approaches to screening included discussions around risks or concerns with swallowing, weight / weight loss or appetite changes. Some respondents described a multi-pronged approach. Members of an MDT such as the Clinical Nurse Specialist (CNS), Consultant or Prehabilitation Coordinator were referenced as being involved in the referral process. Referrals mostly went to community or specialist Dietitians for onward treatment. Despite screening and referral taking place, referral to community dietetic services suggests the timeline for intervention may not be optimal and the intervention may be delivered as a single mode rather than as part of multi-modal prehabilitation.
Physical Activity / Exercise: Validated tools or objective measures to assess functional capacity such the Duke Activity Status Index (DASI), frailty scores, grip strength and Sit to Stand Test were mentioned. Several respondents mentioned patient discussions or visits as a means of undertaking physical activity screening, which included the review of clinical notes. CNSs and Physiotherapists were the primary professionals noted to carry out screening for physical activity and exercise. General open or holistic discussions were also referenced as a route to identify perceived risk. Few details were provided about the onward referral route.
Psychological Need: Screening processes were described for low mood, anxiety or depression, or for support needs. These were typically undertaken using a clinical assessment or Holistic Needs Assessment (HNA), involving tools like the EuroQol 5-Dimension (EQ-5D) health-related quality of life questionnaire. However, a couple of respondents mentioned identifying psychological need as part of a broader conversation about feelings and signposting to services. Screening, where highlighted, was primarily conducted by a Consultant, Nurse or ICJ staff. Where available, onward referrals ranged from in-house programmes and counselling services, to signposting to universal emotional support services.
In many examples given, respondents used the terms screening and assessment interchangeably, although these are different processes with different purposes. Across all three modes of screening, approaches varied from being standardised, for example a routine part of MDT discussions, to more unstructured, for example prompted by risks or concerns identified in consultations. Regarding consultations, elsewhere in open text responses it was acknowledged that sensitive conversations about lifestyle factors require adequate time, as these discussions could be interpreted as judgemental if not approached with care.
Leadership and management
Respondents who identified as Senior Leaders or Service Managers (n=13) were asked about the ways in which they are actively engaged in or leading local activities to see cancer prehabilitation embedded in ways of working and/or pathways of care.
Several highlighted their role in strategic support for project teams in developing and implementing prehabilitation services. Primarily this involved having leadership roles in steering groups and working groups. One respondent mentioned focussing on sustainability, specifically securing recurring funding to deliver prehabilitation for cancer and non-cancer pathways via business cases. Another referenced identifying inequalities and gaps for service planning.
A few Senior Leaders or Service Managers mentioned supporting staff to integrate prehabilitation into specific cancer care pathways or establishing a prehabilitation pathway locally. Cross-sector collaboration was also highlighted, with partnerships involving organisations such as Maggie’s, Macmillan, Apple Clinic, and NHS Boards. In open text questions, wider respondents described the need for broad level leadership and buy in from managers to engage staff from multiple professions in prehabilitation.
Access to services
Understanding of prehabilitation
Many open text responses focused on the need to improve an understanding of prehabilitation amongst people with cancer, staff, and the public. Some felt that people did not become aware of prehabilitation until well after their diagnosis, and that promotional activities and broader public health education could enable healthy living and optimise treatment outcomes. Respondents provided practical suggestions of how to do so, such as staff training, hospital newsletters, or creating an easy summary of prehabilitation resources available. Greater awareness of the benefits of prehabilitation was widely seen as critical for early referral and patient engagement in activities.
Equity and inequalities
Several respondents with services in their local area highlighted inequity in access to prehabilitation services. This was most common in descriptions of services or prehabilitation activities specific to some cancers and not others. While some respondents described expanding prehabilitation services to a wider range of cancers/ cancer types over the past 18 months, prehabilitation services were often described as cancer-specific, linked to funding arrangements. Other groups with perceived barriers to access included people with Stage 1 and Stage 2 cancers, people receiving non-surgical treatment, and those receiving palliative care.
As reported in 2022, socio-economic and geographical barriers to access continued to be highlighted in 2025. One respondent noted that some people with cancer do not own a smart phone. A few mentioned people having to pay for physical activity programmes and affordability as a barrier. Transport issues for people living in rural areas making it difficult to access in-person appointments, particularly those who have co-morbidities, were also raised. Responses highlighted the need for local services and co-ordinated appointments to reduce travel time for patients already facing appointments at different sites. These findings emphasise factors to consider in inclusive service design, particularly when considering digital developments.
Workforce learning
All respondents were asked about their use of the national prehabilitation website, Prehab and Me – Prehabilitation for Scotland, for their own learning or to access resources to support patients. Around one fifth (19%) reported using the website, while a majority reported not doing so, as shown in Table 12.
| Utilise the website? | Number of responses | % of responses to this question |
|---|---|---|
| Yes | 57 | 19% |
| No | 241 | 81% |
| Total responses to this question | 298 | 100% |
When considered by Cancer Network, a higher proportion of respondents in NCA (24%) reported using the website compared with WoSCAN (19%) and SCAN (16%).
When considered by professional groups, Nurses represented the group most likely to report using the website (32%), compared to Physicians (15%), AHPs (13%) and other professionals (19%). Other professionals include Project/ Improvement Managers, Senior Leaders/ Service Managers, and Counsellors/ Psychologists, listed in Annex A.
Uses of Prehab and Me website
55 out of 57 respondents who reported using the national prehabilitation website responded to a follow-up question about the way in which they make use of the website. Signposting patients to information to improve their understanding and engagement was the most common use (75%), followed by learning more about prehabilitation and how to support patients to prepare for the future (47%). This highlights the website’s role in both patient education and staff development amongst users.
| Response statements about uses of website (Select all that apply) | % respondents selecting this statement (n = 55) |
|---|---|
| Signpost patients to information that will help them understand and engage in prehabilitation | 75% |
| Help answer specific questions the patient has about elements of prehabilitation or their suitability for prehabilitation | 15% |
| Help patients learn what additional support is available to them | 40% |
| Help a patient set their own prehabilitation goals | 13% |
| Learn more about prehabilitation and how they can support patients to prepare for what lies ahead | 47% |
| Find out what education and training is available to develop their knowledge and skills in prehabilitation | 27% |
| Access the Key Principles for Implementing Cancer Prehabilitation to guide their work or the development / delivery of their prehabilitation service | 31% |
| Access the Frameworks (nutrition, physical activity and psychological support) that guide their work or the development / delivery of their prehabilitation service | 31% |
| Other | 5% |
‘Other’ responses included use of the website to signpost patients to patient groups, and to teach staff and students about cancer prehabilitation and rehabilitation.
All 302 respondents were asked why they did not make use of the website. 247 responded, including 12 who had previously indicated that they do use the website. Lack of awareness of the website was the most common response (81%), as shown in Table 14. In addition, 14% selected that they did not have sufficient time in a consultation to discuss the website.
| Responses statements about reasons for not using the website (Select all that apply) | Number of respondents | % respondents selecting this statement (n = 247) |
|---|---|---|
| I wasn’t aware of the website | 201 | 81% |
| I don’t have enough time in a consultation to discuss the website | 34 | 14% |
| I don’t think it’s useful or contains the right information | 6 | 2% |
| I don’t have a local website | 8 | 3% |
| Other | 27 | 11% |
‘Other’ reasons included that the website is not applicable to their role or the patient group they interact with most closely, low IT literacy amongst patient groups, a wish to personalise information and resources for patients, and use of local resources.
Other online learning resources
All respondents were presented with a range of learning resources related to prehabilitation and asked to indicate whether they were aware of each. Awareness levels, from most to least commonly known, were as follows:
- 42% reported awareness of Enhanced Recover After Surgery (ERAS) in Scotland TURAS pages
- 26% reported awareness of NHS Scotland Nutrition Framework Education and Training Grid (Appendix 3)
- 21% reported awareness of NHS Scotland Psychological Therapies and Support Framework Education and Training Grid (Appendix 3)
- 18% reported awareness of The Nursing, Midwifery and Health Professions (NMaHP) Perioperative Education and Development site
- 17% reported awareness of Prehab, Rehab and Personalised Care Programme (PRosPer) (NHS England e-learning for health site)
- 12% reported awareness of Moving Medicine Scotland
- 4% reported awareness of Actify
- 3% reported awareness of Perioperative Medicine in Action (UCL short course)
These responses highlight varied levels of awareness of relevant learning resources available, with some resources being more commonly known than others. It is important to note that this reflects awareness rather than the actual use of resources. Results do not indicate whether the resources are being actively used in practice. This could be explored in future surveys.
When describing ways in which local pathways could be improved to optimise patients for treatment, respondents gave a range of suggestions for how to build knowledge, skills and competencies of staff surrounding prehabilitation. These included making links with recognised free online platforms, utilising existing resources such as podcasts, self-help tools and motivational content, pop-up and information events (particularly in remote areas), and integrating prehabilitation into training programmes within professional and vocational training programmes.
Communication and collaboration
Respondents with local prehabilitation activities reflected on communication and collaboration between services, including interactions within local MDTs and local Third Sector organisations. 137 out of a possible 152 respondents with locally available prehabilitation activities provided details.
Multidisciplinary Team (MDT) engagement
Approximately a third (34%) of respondents who provided details on working relationships described close working between staff providing prehabilitation, either as part of an MDT, or with prehabilitation as a core part of the patient pathway after diagnosis. The same proportion (34%) alluded to more variable levels of involvement, for example, noting that some key professions were part of the MDT and not others, or that prehabilitation was delivered by a separate service outside the core clinical team.
As in previous survey results, involvement of the MDT was seen as a key enabler of effective and early prehabilitation. When asked how local pathways could be improved to better support prehabilitation, some suggested more joint MDTs for specific cancer pathways and that prehabilitation should be a regular topic of discussion at meetings. Respondents emphasised the importance of liaising with other staff to identify and refer people with cancer to timely support. One respondent proposed adding a section to the MDT proforma as a useful prompt. Several also highlighted the value of a dedicated coordinator role to facilitate collaboration across services. Coordination of care where targeted or specialist support is needed was additionally seen as important to minimise the number of visits people must make and avoid overwhelming them (see Referrals).
Where prehabilitation falls outside MDTs or is spread across services, there were some positive comments about communication and collaboration, but also other comments that highlighted a need for improvement. Respondents reflected on the need for improved communication among staff, including between primary and secondary care, and with Third Sector and Local Authority service providers. The importance of staff awareness and understanding of the benefits of prehabilitation for good engagement in MDTs was also highlighted.
Collaboration with Third Sector organisations
Several respondents mentioned collaboration with specific Third Sector organisations, mainly the Maggie’s universal prehabilitation workshops and Macmillan ICJ. NHS respondents highlighted partnership working with such services as a potential enabler of effective prehabilitation. Respondents highlighted the contribution of Third Sector organisations offering universal emotional, practical and social support before and after treatment.
However, awareness of these services and working relationships with them varied. While some respondents mentioned a close working relationship, others suggested a more distant working relationship. Those latter respondents stated or implied that local prehabilitation was something separately undertaken by Maggie’s and that the MDT was not involved. This finding may also explain the level of uncertainty amongst respondents about which specific staff were involved in delivering prehabilitation, as described in Staffing. Feedback mechanisms from referrals were suggested as a way in which collaboration could improve local pathways to support prehabilitation. Given the variation in relationships described in responses, there also may be opportunities to share learning from experiences where collaboration between sectors is reported to be effective.
Monitoring, evaluation and outcome measurement
Respondents with local prehabilitation services were asked how patient uptake, adherence and experience were monitored; and how outcome measures were used to determine the effectiveness of those services.
Monitoring and evaluation
Many respondents were uncertain about whether and how monitoring was undertaken. Several explained this was due to monitoring not being part of their role. Monitoring processes mentioned included recording patient referrals, uptake and attendance, and feedback forms or questionnaires.
Patient uptake. Some respondents described monitoring uptake as a shared team responsibility or this being led by a coordinator. Others reported using tools such as spreadsheets or TRAK software to log referrals. A few mentioned conducting audits, and one referred to a process evaluation. Several responses included comments on current levels of patient uptake, although these did not include details on how estimates were derived.
Patient adherence. There was a lot of uncertainty about whether patient adherence was monitored within local programmes. Several respondents reported on activities which were stand-alone sessions and so this was not applicable. Others commented that monitoring was undertaken by Maggie’s. Where data were recorded, this was primarily in the form of statistics such as attendance figures. A few respondents mentioned monitoring via a digital platform where individuals can upload their activity. More qualitative information such as interviews, follow-up phone calls or journals were also mentioned.
Patient experience. Many respondents were unsure about whether or how patient experience was monitored. For those that did provide information, feedback forms or a questionnaire was a common approach. A few mentioned using standardised tools to assess health and quality of life alongside local service satisfaction questionnaires. Monitoring was inferred at various points: at the end of intervention, before surgery, or at specific points throughout a year. Others described gathering more unstructured or informal feedback. Several responses gave accounts of positive patient experiences without citing specific data or metrics.
Outcome measurement
Respondents were asked if outcome measures were used to determine the effectiveness of their prehabilitation activities. 149 out of 152 potential respondents answered. The proportion answering 'Yes' (34%) in 2025 was similar to 2022 (35%). Just under half (44%) indicated that they did not know, as shown in Table 15.
| Use of outcome measures? | Number of responses | % of responses to this question |
|---|---|---|
| Yes | 51 | 34% |
| No | 20 | 13% |
| Don’t know | 66 | 44% |
| Not applicable | 12 | 8% |
| Total responses to the question | 149 | 100% |
Respondents described a range of outcome measures, many of which mirrored the measures reported in 2022. The measures consisted of a blend of validated patient-reported and clinical measures. There were references to using multiple measures, having multiple assessment points, and in one case using a national data base to systematically compare patient outcomes. Measures such as feedback or satisfaction surveys were referenced, although these do not constitute standardised outcome measures.
For Physical Activity / Fitness, the most frequent measures mentioned were functional measures such as Sit to Stand assessments, measures of grip strength, and measures of respiratory or cardiovascular health, such as the Six Minute Walk, Cardiopulmonary Exercise Testing (CPET) and Tidal Volume.
For Nutrition, measures mentioned included oral nutritional supplement usage, weight before and after surgery, and measures of nutrition risk such as via the Patient-Generated Subjective Global Assessment (PG-SGA).
For Psychological Status, patient-reported experience measures were described, such as EuroQol 5-Dimension (EQ-5D) health-related quality of life questionnaire and Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS).
Robust outcome measurement was acknowledged as important. Clinical outcome measures, such as length of hospital stay, post-operative complications, and readmissions, were reported. One respondent mentioned re-screening baseline risk indicators and re-testing functional outcomes, emphasising the importance of aligning processes with current IT systems to effectively evaluate outcomes. Another noted that a process evaluation is currently underway in their area. A test of change was also mentioned locally. Outcome measurement could link to the service availability and resourcing theme. Evidence that prehabilitation leads to positive outcomes could help make the case for longer-term funding and sustainable staffing.
Contact
Email: socialresearch@gov.scot