Walklett Jack, Christensen Alex, Grey Charlotte N B, Barlow Rachael C, McDonald Rhiannon, Davies Alisha R, Mugweni Esther
Public Health Wales, Research, Data and Digital Directorate, No 2 Capital Quarter, Cardiff, UK.
Cardiff and Vale UHB, Prehabilitation Team, Cardiff, UK.
BMC Health Serv Res. 2024 Dec 2;24(1):1525. doi: 10.1186/s12913-024-11964-3.
Evidence suggests that prehabilitation interventions, which optimise physical and mental health prior to treatment, can improve outcomes for surgical cancer patients and save costs to the health system through faster recovery and fewer complications. However, robust, theory-based evaluations of these programmes are needed. Using a theory of change (ToC) approach can guide evaluation plans by describing how and why a programme is expected to work. Theories of Change have not been developed for cancer prehabilitation programmes in the literature to date. This paper aims to provide an overview of the methodological steps we used to retrospectively construct a ToC for Prehab2Rehab (P2R), a cancer prehabilitation programme being implemented by the Cardiff and Vale University Health Board.
We used an iterative, participatory approach to develop the ToC. Following a literature review and document analysis, we facilitated a workshop with fourteen stakeholders from across the programme using a 'backwards mapping' approach. After the workshop, stakeholders had three additional opportunities to refine and validate a final working version of the ToC.
Our process resulted in the effective and timely development of a ToC. The ToC captures how P2R's interventions or activities are expected to bring about short, medium and long-term outcomes that, collectively, should result in the overarching desired impacts of the programme, which were improved patient flow and reduced costs to the health system. The process of developing a ToC also enabled us to have a better understanding of the programme and build rapport with key stakeholders.
The ToC has guided the design of an evaluation that covers the complexity of P2R and will generate lessons for policy and clinical practice on supporting surgical cancer patients in Wales and beyond. We recommend that evaluators apply a ToC development process at the outset of evaluations to bring together stakeholders and enhance the utilisation of the findings. This paper details a pragmatic, efficient and replicable process that evaluators could adopt to develop a ToC. Theory-informed evaluations may provide better evidence to develop and refine cancer prehabilitation interventions and other complex public health interventions.
有证据表明，术前康复干预措施（即在治疗前优化身心健康）可改善癌症手术患者的治疗效果，并通过更快康复和减少并发症来降低卫生系统成本。然而，需要对这些项目进行基于理论的有力评估。运用变革理论（ToC）方法可以通过描述项目预期的运作方式和原因来指导评估计划。迄今为止，文献中尚未针对癌症术前康复项目制定变革理论。本文旨在概述我们用于回顾性构建“从术前康复到术后康复（P2R）”项目变革理论的方法步骤，该项目由加的夫和韦尔大学健康委员会实施。
我们采用迭代式参与方法来构建变革理论。在进行文献综述和文件分析之后，我们使用“逆向映射”方法，为来自该项目各方面的14名利益相关者组织了一次研讨会。研讨会之后，利益相关者还有另外三次机会完善和验证变革理论的最终工作版本。
我们的流程有效且及时地构建了变革理论。该变革理论阐述了P2R的干预措施或活动预期如何带来短期、中期和长期结果，这些结果共同应能实现该项目的总体预期影响，即改善患者就医流程并降低卫生系统成本。构建变革理论的过程还使我们能够更好地理解该项目，并与关键利益相关者建立融洽关系。
变革理论为涵盖P2R复杂性的评估设计提供了指导，并将为威尔士及其他地区支持癌症手术患者的政策和临床实践提供经验教训。我们建议评估人员在评估开始时应用变革理论构建流程，以汇聚利益相关者并提高研究结果的利用率。本文详细介绍了评估人员可采用的务实、高效且可复制的构建变革理论的流程。基于理论的评估可能会为开发和完善癌症术前康复干预措施及其他复杂的公共卫生干预措施提供更好的证据。
