Creating a remote prehabilitation programme to overcome physical barriers
Due to COVID-19 lockdown, the Kent and Medway Prehabilitation Programme team were unable to conduct face-to-face consultations with their cancer patients, a number of whom who were also shielding. Prehabilitation has been shown to improve the health and fitness of cancer patients through providing nutritional advice, exercise, and psychological support. It aims to help prepare patients for their treatment by making them feel both physically, and mentally stronger.
Prior to COVID-19, prehabilitation was a hospital-based programme. The programme serves as a vital touchpoint to optimise patients’ peri-operative functional status. To overcome the geographical distance between patients and staff, the team developed a remote programme to support patients. A key aim of this work was to allow equitable access to the treatment by making it flexible and adaptable to suit patient needs. Patients underwent prehabilitation for a minimum of four weeks prior to their cancer treatment. The programme comprised of four interventions which would be prescribed to patients following an initial telephone consultation with a physiologist, and screening for modifiable risk factors.
The four interventions were:
• home-based exercises
• provision of nutritional advice
• psychosocial support and guidance, and
• the promotion of healthier lifestyles.
Additionally, the team linked patients to the wellbeing navigation team for further support if needed. This would range from helping with applying for benefit and attendance allowance, to getting dog walking services or accessing a food bank.
Based on patient preference, the four interventions were delivered either via telephone, video calls, as on-line resources, or by post. Providing these options ensured patients could pick the methods that suited them best. The exercise physiologist pre-recorded videos to enable patients to exercise at home safely. A member of the prehabilitation team would also call the patient twice a week to check-in, and provide additional support. The flexible delivery of the programme meant that patients working full-time could arrange to have their remote consultations at times that best suited them.
When designing the new remote programme the team sought guidance from the service’s patient steering group to ensure its suitability. Currently in the process of conducting a formal evaluation of the programme, the team have reported a compliance rate of 98% and have received more than 60 referrals across the county, overcoming a previous restriction that limited delivery of face-to-face care only to patients within the Medway area. Additionally, the team have received positive feedback that having a regular connection with staff reduced patient stress and anxiety, improving their mental wellbeing.