Background and Aims:
Delivering equitable, high-quality prehabilitation to patients with gastrointestinal (GI) cancers across Australia's diverse geographical landscape remains a persistent challenge. This presentation traces the evolution of our prehabilitation research program, from early hospital-based models through to community, telehealth, and next-generation stratified approaches, guided at every stage by consumer feedback and an unwavering commitment to accessibility and effectiveness.
Methods:
We conducted a series of sequential, consumer-informed trials: a hospital-based prehabilitation trial (PEPA), a community-based model (PRIORITY), and a telehealth-delivered approach (PRIORITY-CONNECT 2). Each iteration was shaped by systematic consumer consultation to address barriers identified in the preceding model. Building on this foundation, we have since developed two emerging frameworks, PREDICT, which leverages prognostic data to identify patients most likely to benefit from prehabilitation, and PRISM (Prehabilitation Resource Intensity Stratification Model), a methodological framework designed to match intervention intensity to individual patient risk and need.
Results:
PEPA demonstrated meaningful clinical benefits but revealed significant barriers including travel demands and financial burden. Consumer engagement in PRIORITY showed that a community-based model improved accessibility and strengthened peer support networks. PRIORITY-CONNECT 2 further extended reach through telehealth, overcoming geographical and digital barriers while enabling greater family involvement in care. Together, these trials illustrate how continuous consumer-centred design can meaningfully reshape healthcare delivery for GI cancer patients. Looking ahead, PREDICT and PRISM offer promising pathways toward more personalised, resource-efficient prehabilitation, ensuring the right intervention reaches the right patient at the right time, regardless of where they live.
Conclusions:
The systematic evolution of our prehabilitation program reflects an evidence-based, consumer-driven approach to embedding prehabilitation into routine cancer care at scale. From hospital corridors to living rooms, and now toward precision stratification, this journey offers a blueprint for designing equitable, adaptable surgical prehabilitation models across diverse healthcare settings.