Considerations for multimodal prehabilitation in women with gynaecological cancers: A realist scoping review

Abstract Background: There is increasing recognition that prehabilitation is important as a means of preparing patients physically and psychologically for cancer treatment, however, little is understood about the role of prehabilitation for gynaecological cancer patients. Review question: This scoping review was conducted to collate the research evidence on multimodal prehabilitation in gynaecological cancers and the related barriers and facilitators to delivery and engagement that should be considered when designing a prehabilitation model for this group of women. Methods: Seven medical databases and four grey literature repositories were searched from database inception to September 2021. All articles, except for opinion papers and social media posts, surrounding multimodal prehabilitation in gynaecological cancers were included in the final review. All qualitative papers including gynaecological cancer patients were included, irrespective of whether the intervention of interest was unimodal or multimodal. A realist framework of context, mechanism and outcome was used to assist interpretation of findings. Results: In total, 24 studies were included in the final review. The studies included the following tumour groups: ovarian only (n=12), endometrial only (n=1), mixed ovarian, endometrial, vulvar (n=5) and non-specific gynaecological tumours (n=6). There was considerable variation across studies in terms of screening, delivery of prehabilitation and measured outcomes. Key mechanisms and contexts underpinning engagement with prehabilitation can be summarised by 5 overarching themes: 1) The role of healthcare professionals and organisations 2) Acceptability of prehabilitation 3) Patient motivation 4) Prioritisation of prehabilitation 5) Accessibility of prehabilitation. Implications for practice: A standardised and well evidenced prehabilitation programme for women with gynaecological cancer does not yet exist. Healthcare organisations and researchers should take into account the enablers and barriers to effective engagement by healthcare professionals and by patients, when designing and evaluating prehabilitation for gynaecological cancer patients.