Cancer Prehabilitation: Staff perspectives on implementation

Methodology

Design and approach

A focus group approach was chosen as a time‑efficient method to gain a deeper understanding of the attitudes and perspectives of a range of professionals involved in cancer prehabilitation. Seven online focus groups (December 2025-January 2026) were conducted with 32 staff across the National Health Service (NHS), third sector, the leisure sector and other organisations (see Annex A). Participants were drawn from survey respondents in 2025 who consented to be recontacted and via targeted outreach to three organisational bodies representing professional groups who were under-represented in the survey^[1]. Groups were mixed by role and organisation to elicit diverse perspectives on the same topic, with participants’ preference for topic of focus group accommodated where possible.

Ethics and data protection

A Data Protection Impact Assessment (DPIA) was completed at the outset of the project. Ethical considerations were reviewed internally in line with Scottish Government ethics guidance^[15], to align the project with Government Social Research (GSR) standards^[16]. Participants received an information sheet, privacy notice and consent form by email in advance of focus groups (Annex B).

Data collection

A topic guide (two variants) was used to explore topics of ‘pathways and partnerships’ and ‘service redesign, renewal and sustainability’ (Annex C). These issues were consistently raised in the 2022 and 2025 surveys but required deeper exploration to identify solutions, so they were divided into two topics to keep the time commitment reasonable for participants. Topic guides were reviewed by the Cancer Prehabilitation Oversight Group and the Scottish Government cancer policy team for clarity and relevance.

Sessions were limited to 60 minutes and were held online to make it easier for staff to participate across different geographical settings. Focus groups were jointly facilitated by a Scottish Government social researcher and the Macmillan National Improvement Advisor for Cancer Prehabilitation. Eighty seven survey respondents registered to be re-contacted for the purposes of focus groups, of which 53 returned an MS Form indicating their availability. Thirty nine staff had sufficient overlapping time slots to be allocated a focus group session. Of the seven who withdrew the reasons were primarily due to illness, connectivity issues, or unexpected clinical commitments. Facilitators debriefed after each group to discuss and record their reflections.

Analysis

Automated transcriptions of the sessions were generated by Microsoft Teams. These were checked for accuracy and anonymised by the researcher. Transcripts were manually coded within MaxQDA, a qualitative data management and analysis tool, by the researcher. Coding was at first iterative and open using participants’ own language where possible. A second researcher coded a subset of transcripts for quality assurance. Annex D describes this collaborative coding process in more detail. Following discussions within the research team, codes were interpreted into themes from across transcripts, rather than individual narratives. Ideas for future focus were categorised as ‘quick wins’ either when participants explicitly identified them as such, or when ideas raised at other points during the focus group were assessed by the researcher as low effort and have potential for high impact. These ideas were tested with policy officials and the Macmillan National Improvement Advisor for Cancer Prehabilitation for feasibility.

At the final stage of analysis, MaxQDA’s AI-Assist functions were used to support analysis, specifically for checking for consistency in coding, developing code summaries and locating and extracting segments from transcripts. M365 Copilot, based on GPT-5 chat model, was used to improve the readability of the report and summarise findings for the Executive Summary. AI has been used in strict accordance with Scottish Government guidance and is not a standalone source of evidence. Any AI generated content has been quality assured by humans to ensure research accuracy and integrity, and there is no verbatim reproduction of AI content in this document without human review. The author retains ultimate responsibility for AI content used in this research.

Limitations

There are a number of limitations associated with these focus groups to note:

• Representation: The sample of staff who took part in focus groups does not provide a complete or representative picture of all staff working in cancer prehabilitation. Cancer prehabilitation staff are a dispersed group with respect to professional roles and care settings, and while we attempted to get a spread of roles across groups, there will be staff stakeholder perspectives missed. Notably from General Practitioners (GPs), Clinical Psychologists, Counsellors, Occupational Therapists, Pharmacists, and volunteers.
• Self-selection: The sample of staff who participated in focus groups are likely those motivated to participate in research about cancer prehabilitation and therefore the findings may under-represent those with a more neutral or sceptical view. This may be particularly relevant given that focus groups took place over winter, when workloads are often at their heaviest.
• Focus group dynamics: There are well‑recognised biases associated with focus group data collection, including social desirability bias (where participants provide responses they believe will be more socially acceptable than their true views), ‘group think’ bias (where participants conform to more dominant opinions), and moderator bias (where facilitators influence responses, for example, through verbal or non‑verbal cues). These issues were considered in advance of the focus groups through the ethics checklist, and focus group design aimed to minimise their impacts. However, it is acknowledged that such biases may still have influenced the data.
• Scope: This project considered the implementation of cancer prehabilitation from staff perspectives. Staff perspectives on the availability and roll out of prehabilitation may differ from a lived experience perspective, which is not included in the scope of this analysis, which builds on a survey of staff.

Please note that while themes are presented thematically, this does not imply consensus. The number of participants is included where appropriate to illustrate the weight and range of views expressed. In addition, participants’ professions are provided alongside quotations for context, but this should not be taken to mean that the participant’s view is representative of their professional group.

Within the analysis, the term ‘prehab’ is used as an abbreviation of prehabilitation, as this was the preferred terminology for participants and therefore used to reflect participant understandings when they use this term.