Barriers and enablers to exercise prehabilitation before breast cancer surgery in an Australian regional health service: patient and clinician perspective.

Abstract

Purpose: To identify barriers and enablers of an exercise-based prehabilitation service for surgical patients with breast cancer and medical professionals in a regional healthcare setting.

Methods: A cross-sectional survey was distributed to patients with breast cancer and medical professionals from regional populations. Surveys included closed and open-ended responses. A chi-square goodness of fit test with a Fisher's exact correction was used for quantitative analysis of the frequencies of barriers and enablers within groups. Content analysis was used for open-ended responses.

Results: Twenty-five patients and 14 clinicians participated. Patients identified psychological barriers as the lowest concern to exercise prehabilitation (χ²(9, n = 23) = 21.78, p = .011). No other patient barriers were statistically significant. Fifty-nine percent of patients expressed interest in participation in exercise prehabilitation, with 40% citing personal fitness benefits as the leading enabler. Clinicians identified time constraints as a barrier (χ²(2, n = 13) = 8.00, p < .05), with challenges integrating prehabilitation into pre-surgery timelines. Clinicians indicated electronic referral methods and information would be enablers for prehabilitation.

Conclusion: The study underpins the need for integrating exercise professionals into preoperative teams to address exercise prehabilitation within limited time frames. Patients do not describe psychological barriers and instead report motivation to improve fitness as an enabler of prehabilitation. Clinicians report time constraints in pre-operative appointments as a barrier to prehabilitation. Implementing electronic referral methods alongside traditional approaches may enhance prehabilitation delivery for patients receiving breast cancer surgery. Future research should leverage these findings for prehabilitation referral and program design.