PREHAB-GI was an implementation study evaluating a multimodal prehabilitation program for patients undergoing colorectal and upper gastrointestinal cancer surgery at Concord Repatriation General Hospital. The program combined supervised exercise, nutrition and nursing support, delivered face-to-face or by telehealth in response to COVID-19 restrictions. Implementation was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.
Between January 2020 and December 2021, 181 patients were screened, 91 were eligible, and 77 commenced prehabilitation. Insufficient time before surgery (<2 weeks) was the most common reason for ineligibility. The median intervention duration was 16 days, 94% completed the program, and adherence and satisfaction were high. Functional capacity, anxiety and quality of life improved before surgery. Following completion of the study, the program entered a maintenance phase and continued within clinical care with modifications.
While PREHAB-GI demonstrated that multimodal prehabilitation could be successfully implemented within a real-world gastrointestinal cancer service during the research phase, it was not without difficulty. COVID-19 required rapid adaptation of delivery, while access barriers, multidisciplinary coordination, workforce capacity and limited dedicated funding challenged implementation and sustainability. The program’s success reflected not only the intervention, but also the commitment and adaptability of the clinical team.
Discussion will explore patient and clinician perspectives on PREHAB-GI, alongside a clinician perspective on the barriers and enablers encountered during implementation. The impact of COVID-19, the transition from a research study to clinical care, the less visible work required to establish a new service, and the limitations of relying on clinical goodwill without dedicated staffing and funding will be discussed. Ultimately, PREHAB-GI highlights the difference between demonstrating that prehabilitation can be delivered and embedding it as a sustainable model of care.