Cancer Prehabilitation: Staff perspectives on implementation

Recommendations

• Review and update cancer pathways so that prehabilitation is the default option for patients (opt-out). NHS Boards should review and update pathways to support and embed cancer prehabilitation as an opt-out pathway. CPOG or Regional Cancer Networks to share good practice case studies of where this is happening in practice, and promote lessons learned from other parts of the UK.
• Create prompts for different healthcare professions to support the delivery of prehabilitation. Scottish Government and NHS Boards should consider prompts for different professionals involved in cancer care to support the delivery of prehabilitation at relevant points in the pathway. This may include awareness raising amongst professionals, to foster a whole team approach towards, and more consistent messaging about, prehabilitation.
• Actively build familiarity and trust between delivery partners. Support across all levels (local, regional and national) to encourage communication and increased trust in partnerships. This could include support to service managers or leaders to meet partners face to face, map services, communicate regularly or establish assurances of training and governance for prehabilitation roles.
• Pilot specific support to improve access and uptake among groups who experience barriers to universal prehabilitation. Service managers or leads could promote better recording of equalities characteristics of those attending universal prehabilitation, and pilot co-design approaches with those missing from universal prehabilitation services to test whether this improves uptake.
• Develop a minimum data set for prehabilitation to support the monitoring and evaluation of prehabilitation services, improve data quality and consequently provide robust evidence on the costs and benefits of prehabilitation.
• Propose cancer prehabilitation as a candidate for the next phase of the Digital Front Door rollout . Recognising differential access to digital technology, Scottish Government and COSLA could put forward cancer prehabilitation as a test site for Digital Front Door, to support systematic recording by patients and professionals of prehabilitation screening, assessment and outcomes data.
• Clarify roles and responsibilities of prehabilitation workforce roles including that of CNS, health care support worker and/or navigators in relation to their roles in different points in the prehabilitation pathways. This should cover navigation and support with particular tasks - both clinical and administrative tasks, while ensuring that cancer prehabilitation remains a shared responsibility of the multidisciplinary team.