Physiotherapy - Theses
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ItemMultidisciplinary prehabilitation in clinical practice for haematologic patients receiving high dose chemotherapy with autologous stem cell transplant( 2023-04)Autologous stem cell transplant (AuSCT) is an intensive treatment for patients with haematologic cancer, with the potential for significant functional and psychological decline. Cancer prehabilitation is a package of care provided prior to major oncological treatment that aims to mitigate this decline. Currently the predominance of prehabilitation evidence is in efficacy trials in surgical cohorts. In these populations, findings for prehabilitation are broadly favourable. Despite this, the uptake of routine prehabilitation into clinical services remains low, especially in Australia. Hence, evidence evaluating implementation and effectiveness of prehabilitation in clinical practice is limited. Research examining prehabilitation in real-world settings is needed to inform further service development. The studies reported in this thesis aimed to (1) evaluate the impact of a new allied health prehabilitation service for haematologic patients receiving AuSCT in a tertiary cancer centre; and (2) identify health care professionals’ (HCPs) perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to AuSCT. Study one analysed 12 months of prospectively collected data. Impact and operational success were investigated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Patients were representative of Australian AuSCT patients on key demographic variables and clinically relevant improvements in outcomes were demonstrated, however missing data were an issue. The service was well adopted by clinicians and fidelity of exercise prescription (Implementation) was moderate. The referral trend over time (Maintenance) was high after the initiation period. Study two was based on the Theoretical Domains Framework (TDF) of behaviour change. Fourteen HCPs at a tertiary cancer centre participated in semi-structured interviews based on the TDF. Novel findings included the predominance of reported enablers in comparison to barriers. Enablers included: the belief that patients will benefit from prehabilitation; and that face-to-face initial assessments and multidisciplinary teamwork are essential. These studies evaluated prehabilitation in clinical practice prior to AuSCT and provided original contributions to knowledge in this area. Evidence informed recommendations for prehabilitation service delivery are presented, that may support implementation of prehabilitation programs in hospital settings where uptake remains low. Findings may not be generalisable to all oncology populations and settings, in particular, organisations in which prehabilitation is not already included in hospital policy. There is scope for further research into prehabilitation implementation solutions, to inform best practice care and improve outcomes.