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. 2024 Apr 26;24(1):536.
doi: 10.1186/s12913-024-10993-2.

Barriers and facilitators to the implementation of prehabilitation for elderly frail patients prior to elective surgery: a qualitative study with healthcare professionals

Tamina Isabel Fuchs  1 , Carina Pfab  1   2 , Jörn Kiselev  3   4 , Stefan J Schaller  3   5 , Claudia Spies  3 , Tanja Rombey  6
Affiliations

Barriers and facilitators to the implementation of prehabilitation for elderly frail patients prior to elective surgery: a qualitative study with healthcare professionals

Tamina Isabel Fuchs et al. BMC Health Serv Res. .

Abstract

Background: Prehabilitation aims to enhance functional capacity before surgery, minimise complications and achieve a better postoperative outcome. This can be particularly useful for older, frail patients to better tolerate surgery. The aim of this study was to identify what barriers and facilitators healthcare professionals in Germany experienced in the implementation and delivery of the multimodal prehabilitation programme "PRAEP-GO" for (pre-)frail adults aged 70 years and older to inform the implementation of prehabilitation into standard care.

Methods: A nested descriptive qualitative study was conducted using semi-structured face-to-face interviews with healthcare professionals involved in the PRAEP-GO trial from the Berlin and Brandenburg region in Germany. Transcripts were analysed using Kuckartz' qualitative content analysis. Results were interpreted and synthesised using the Consolidated Framework for Implementation Research, a theoretical framework to allow their application to a more general context.

Results: A total of 14 interviews were conducted. Seven therapists (physio-, ergo-, sports therapy), five physicians and two employees from other professions with mainly administrative and organisational tasks in the project. All identified barriers and facilitating factors could be assigned to the themes of organisation, prehabilitation, cooperation and communication between healthcare professionals and with patients. Much optimisation potential was found regarding organisational aspects, e.g. addressing perceived staff shortages and optimising the patient pathway. Furthermore, it became apparent that communication and cooperation between professionals but also with patients need to be improved. More evidence regarding prehabilitation should be provided to convince professionals more. Prehabilitation should be multimodal and individualised, including the programme duration. Officially introducing prehabilitation into standard care would facilitate its delivery.

Discussion: These findings underscore the fact that successful implementation of prehabilitation programmes, such as PRAEP-GO, requires sufficient organisational infrastructure, human resources, access to knowledge, an adaptable and individualised programme design as well as good communication among professionals and with patients. The transferability of the findings is limited by the absence of nutritionists and resulting overrepresentation of other therapists in the sample. To further convince professionals and patients of the concept of prehabilitation, more research is needed to build a solid evidence base that will ensure greater awareness and, thus, more motivation and cooperation among professionals and patients.

Trial registration: Open Science Framework (osf.io/ksfgj).

Keywords: Barriers; Facilitators; Frailty; Implementation; Prehabilitation; Qualitative study.

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Conflict of interest statement

TIF performed the research as part of her master’s thesis and declares no financial conflict of interest. CP declares no financial conflict of interest. JK, SJS, CS and TR are involved in an ongoing randomised clinical trial on prehabilitation in the frail elderly (PRAEP-GO; ClinicalTrials.gov identifier NCT04418271) funded by the Innovationsfonds des Gemeinsamen Bundesausschusses. JK declares no financial conflict of interest. SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. SJS holds stocks in small amounts from Alphabeth Inc., Bayer AG and Siemens AG; these holdings have not affected any decisions regarding his research or this study. CS reports grants from Innovationsfonds des Gemeinsamen Bundesausschusses, Bundesministerium für Bildung und Forschung, Bundesministerium für Gesundheit/Robert Koch-Institut, Deutsche Forschungsgemeinschaft, Deutsches Zentrum für Luft- und Raumfahrt e. V., Einstein Stiftung Berlin, Inneruniversitäre Forschungsförderung, European Society of Anaesthesiology and Intensive Care, Baxter Deutschland GmbH, Cytosorbents Europe GmbH, Edwards Lifesciences Germany GmbH, Fresenius Medical Care, Grünenthal GmbH, Masimo Europe Ltd., Pfizer Pharma GmbH, Dr. F. Köhler Chemie GmbH, Sintetica GmbH, Stifterverband für die deutsche Wissenschaft e.V./Phillips, Stiftung Charité, AGUETTANT Deutschland GmbH, AbbVie Deutschland GmbH & Co. KG, Amomed Pharma GmbH, InTouch Health, Copra System GmbH, Correvio GmbH, Max-Planck-Gesellschaft zur Förderung der Wissenschaften e.V., Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin, Stifterverband für die deutsche Wissenschaft e.V./Metronic, Philips Electronics Nederland BV, Drägerwerk AG & Co. KGaA; personal fees from Georg Thieme Verlag, all outside the submitted work. TR received honorary fees for commissioned research by the Statutory Health Insurance Medical Review Board outside the submitted work.

Figures

Fig. 1
Fig. 1
Flow model of a content structuring content analysis; own figure according to Kuckartz (2018) [36]
Fig. 2
Fig. 2
Synthesis of results using the updated CFIR framework; own figure
See this image and copyright information in PMC

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