Shen Chen, Gu Lianqi, Li Na, Wang Rao, Yang Xin, Chu Zhiping
School of Nursing, Nanjing Medical University, Nanjing, China.
The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Br J Health Psychol. 2024 May;29(2):395-429. doi: 10.1111/bjhp.12705. Epub 2023 Nov 20.
Prehabilitation, which is the process of enhancing functional capacity before undergoing surgery or other treatments, has been shown to improve cancer patients' outcomes. Patient and healthcare provider attitudes and perceptions are essential factors in the successful implementation of prehabilitation. The purpose of this systematic review is to synthesize qualitative evidence and explore the barriers and facilitators to prehabilitation implementation.
From the earliest available date to October 2023, 7 databases (PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE) were searched for a systematic review. Data were extracted, thematically analysed, and mapped onto the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). The Critical Appraisal Skills Programme (CASP) tool was used to assess the quality of the studies.
A total of 26 studies were included, involving 377 patients, 51 caregivers, and 156 healthcare providers. 16 factors were identified and mapped onto the COM-B model: reflective/automatic motivation, physical/social opportunity, physical/ psychological capability.
Patients and healthcare provides identified a lack of reflective motivation and physical opportunities as the most significant barriers to engagement in prehabilitation. Personalized approaches, social support, and healthcare providers' engagement are key factors for prehabilitation. Future research should focus on developing effective interventions to enhance the uptake and sustainability of prehabilitation.
术前康复是指在接受手术或其他治疗前增强功能能力的过程，已被证明可改善癌症患者的治疗效果。患者及医疗服务提供者的态度和认知是术前康复成功实施的关键因素。本系统评价的目的是综合定性证据，探讨术前康复实施的障碍和促进因素。
从最早可获取日期至2023年10月，检索了7个数据库（PubMed、科学网、考克兰图书馆、Embase、护理学与健康领域数据库、心理学文摘数据库和医学期刊数据库）进行系统评价。提取数据，进行主题分析，并映射到行为的能力、机会和动机模型（COM-B模型）上。使用批判性评估技能计划（CASP）工具评估研究质量。
共纳入26项研究，涉及377名患者、51名护理人员和156名医疗服务提供者。确定了16个因素并映射到COM-B模型上：反思性/自动动机、身体/社会机会、身体/心理能力。
患者和医疗服务提供者认为缺乏反思性动机和身体机会是参与术前康复的最主要障碍。个性化方法、社会支持和医疗服务提供者的参与是术前康复的关键因素。未来的研究应侧重于开发有效的干预措施，以提高术前康复的接受度和可持续性。
