Barriers and facilitators to physical activity prehabilitation in patients with kidney cancer

Cristiany M Paulo; Adil A Ali; Benjamin N Schmeusser; Eric Midenberg; Talia A Helman; Maggie L Diller; Martijn F Pisters; Kenneth Ogan; Viraj A Master

doi:10.1016/j.ejon.2023.102333

Barriers and facilitators to physical activity prehabilitation in patients with kidney cancer

Eur J Oncol Nurs. 2023 Aug:65:102333. doi: 10.1016/j.ejon.2023.102333. Epub 2023 May 7.

Authors

Cristiany M Paulo¹, Adil A Ali¹, Benjamin N Schmeusser², Eric Midenberg³, Talia A Helman¹, Maggie L Diller⁴, Martijn F Pisters⁵, Kenneth Ogan¹, Viraj A Master⁶

Affiliations

¹ Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA.
² Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
³ Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA.
⁴ Department of Surgery of Emory University, 1364 Clifton Road, Atlanta, GA, 30322, USA.
⁵ Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands.
⁶ Department of Urology, Emory University, 1364 E Clifton Rd NE, Atlanta, GA, 30322, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA. Electronic address: vmaster@emory.edu.

PMID: 37295278
DOI: 10.1016/j.ejon.2023.102333

Abstract

Purpose: Timely and effective physical activity (PA) prehabilitation is an evidence-based approach for improving a patient's health status preoperatively. Identifying barriers and facilitators to PA prehabilitation can help inform best practices for exercise prehabilitation program implementation. We explore the barriers and facilitators to PA prehabilitation in patients undergoing nephrectomy.

Methods: A qualitative exploratory study was conducted by interviewing 20 patients scheduled for nephrectomy. Interviewees were selected via convenience sampling strategy. The interviews were semi-structured and discussed experienced and perceived barriers/facilitators to PA prehabilitation. Interview transcripts were imported to Nvivo 12 for coding and semantic content analysis. A codebook was independently created and collectively validated. Themes of barriers and facilitators were identified and summarized in descriptive findings based on frequency of themes.

Results: Five relevant themes of barriers to PA prehabilitation emerged: 1) mental factors, 2) personal responsibilities, 3) physical capacity, 4) health conditions, and 5) lack of exercise facilities. Contrarily, facilitators potentially contributing to PA prehabilitation adherence in kidney cancer included 1) holistic health, 2) social and professional support, 3) acknowledgment of health benefits, 4) exercise type and guidance, and 5) Communication channels.

Conclusion and key findings: Kidney cancer patient's adherence to physical activity prehabilitation is influenced by multiple biopsychosocial barriers and facilitators. Hence, adherence to physical activity prehabilitation requires timely adaptation of health beliefs and behavior embedded in the reported barriers and facilitators. For this reason, prehabilitation strategies should strive to be patient-centered and include health behavioral change theories as underlying frameworks for sustaining patient engagement and self-efficacy.

Keywords: Exercise; Nephrectomy; Oncology; Prehabilitation; Renal cell carcinoma; Surgery.

MeSH terms

Exercise
Humans
Kidney Neoplasms* / surgery
Preoperative Exercise*
Qualitative Research