Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, Charing Cross Hospital, 13th Floor Laboratory Block, Fulham Palace Road, London, W6 8RF, UK.
Medical Library, Chelsea and Westminster Campus, Imperial College London, Fulham Road, London, UK.
BMC Womens Health. 2022 Jul 19;22(1):300. doi: 10.1186/s12905-022-01882-z.
There is increasing recognition that prehabilitation is important as a means of preparing patients physically and psychologically for cancer treatment. However, little is understood about the role and optimal nature of prehabilitation for gynaecological cancer patients, who usually face extensive and life-changing surgery in addition to other treatments that impact significantly on physiological and psychosexual wellbeing.
This scoping review was conducted to collate the research evidence on multimodal prehabilitation in gynaecological cancers and the related barriers and facilitators to engagement and delivery that should be considered when designing a prehabilitation intervention for this group of women.
Seven medical databases and four grey literature repositories were searched from database inception to September 2021. All articles, reporting on multimodal prehabilitation in gynaecological cancers were included in the final review, whether qualitative, quantitative or mixed-methods. Qualitative studies on unimodal interventions were also included, as these were thought to be more likely to include information about barriers and facilitators which could also be relevant to multimodal interventions. A realist framework of context, mechanism and outcome was used to assist interpretation of findings.
In total, 24 studies were included in the final review. The studies included the following tumour groups: ovarian only (n = 12), endometrial only (n = 1), mixed ovarian, endometrial, vulvar (n = 5) and non-specific gynaecological tumours (n = 6). There was considerable variation across studies in terms of screening for prehabilitation, delivery of prehabilitation and outcome measures. Key mechanisms and contexts influencing engagement with prehabilitation can be summarised as: (1) The role of healthcare professionals and organisations (2) Patients' perceptions of acceptability (3) Factors influencing patient motivation (4) Prehabilitation as a priority (5) Access to prehabilitation.
A standardised and well evidenced prehabilitation programme for women with gynaecological cancer does not yet exist. Healthcare organisations and researchers should take into account the enablers and barriers to effective engagement by healthcare professionals and by patients, when designing and evaluating prehabilitation for gynaecological cancer patients.
人们越来越认识到，预康复作为一种使患者在身体和心理上为癌症治疗做好准备的手段非常重要。然而，对于妇科癌症患者，人们对预康复的作用和最佳性质知之甚少，这些患者除了其他对生理和性健康有重大影响的治疗外，通常还需要接受广泛的、改变生活的手术。
本范围界定综述旨在收集多模式预康复在妇科癌症中的研究证据，以及在为这组女性设计预康复干预措施时应考虑的与参与和实施相关的障碍和促进因素。
从数据库建立到 2021 年 9 月，对 7 个医学数据库和 4 个灰色文献库进行了搜索。最终综述纳入了所有报告妇科癌症多模式预康复的文章，无论其为定性、定量还是混合方法研究。还纳入了关于单模式干预的定性研究，因为这些研究更有可能包含与多模式干预相关的障碍和促进因素的信息。使用真实主义框架（上下文、机制和结果）来协助解释研究结果。
最终综述共纳入 24 项研究。这些研究包括以下肿瘤组：仅卵巢肿瘤（n=12）、仅子宫内膜肿瘤（n=1）、混合卵巢、子宫内膜、外阴肿瘤（n=5）和非特定妇科肿瘤（n=6）。在预康复筛查、预康复实施和结果测量方面，各研究之间存在很大差异。影响参与预康复的关键机制和背景因素可以概括为：（1）医疗保健专业人员和组织的作用（2）患者对可接受性的看法（3）影响患者动机的因素（4）预康复的优先级（5）获得预康复的机会。
针对妇科癌症女性的标准化、有充分证据的预康复方案尚未存在。医疗保健组织和研究人员在设计和评估妇科癌症患者的预康复时，应考虑医疗保健专业人员和患者有效参与的促进因素和障碍。
