Development of a remotely supervised digitally facilitated multibehavioural prehabilitation intervention for patients approaching major surgery

Durrand, James William (2022) Development of a remotely supervised digitally facilitated multibehavioural prehabilitation intervention for patients approaching major surgery. Doctoral thesis, Northumbria University.

Preview

Text (Doctoral thesis) durrand.james_phd (16043645).pdf - Submitted Version Download (7MB) | Preview

Abstract

Improving outcomes following major surgery is a pressing public health challenge. Postoperative complications drive surgical mortality and a range of poorer outcomes for the individual patient (e.g., quality of life) and wider healthcare system (e.g., length of stay and cost). Preoperative improvement of physical and mental health enhancing readiness for major surgery is known as prehabilitation. Patients may experience fewer postoperative complications and overcome them more easily. Multiple prehabilitation models now exist. Delivery has been predominantly face to face, yet demand is growing for robustly developed, remotely supervised alternatives. The need is now acute following the Covid-19 pandemic. Little is known regarding patient preferences for remotely supervised prehabilitation. Equally, few systematically designed interventions currently exist. This thesis addresses these gaps. A discrete choice experiment undertaken in 164 patients preparing for major surgery across 10 NHS centres explored patient preferences for delivery of support. This work highlighted both appetite for remotely supervised models and strong views regarding their delivery. In particular, demand for a digitally facilitated option. This informed the application of a systematic co-design process utilising the Behaviour Change Wheel to develop a novel, multibehavioural, digitally facilitated prehabilitation programme prototype (iPREPWELL). This work aligned to the Medical Research Council framework for complex intervention development and encompassed structured questionnaires, semi-structured interviews and workshops involving patients preparing for major surgery and perioperative healthcare professionals. These data were combined with the existing evidence base and the input of a multidisciplinary design team. iPREPWELL is the first comprehensively theory and evidence informed intervention of its kind. The programme is poised and approved for feasibility testing in patients approaching major surgery at two NHS centres. If successful, it may offer services a route to improved uptake of prehabilitation support, with potential for flexible and cost-effective implementation across a range of surgical pathways.

Actions (login required)

View Item

Downloads