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Experiences of patients enrolled and staff involved in the prehabilitation of elective patients undergoing cardiac surgery trial: a nested qualitative study

Lookup NU author(s): Professor Helen Hancock, Michelle Bardgett, Ayesha Mathias, Professor Enoch AkowuahORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.The purpose of this study was to understand the views and experiences of patients enrolled and staff involved in the prehabilitation of elective patients undergoing cardiac surgery trial. This sub-study was informed by normalisation process theory, a framework for evaluating complex interventions, and used consecutive sampling to recruit patients assigned to both the intervention and control groups. Patients and all staff involved in delivering the trial were invited to participate in focus groups, which were recorded, transcribed verbatim and subjected to reflexive thematic analysis. Five focus groups were held comprising 24 participants in total (nine patients assigned to the prehabilitation; seven assigned to control; and eight staff). Five themes were identified. First, preparedness for surgery reduced fear, where participants described that knowing what to expect from surgery and preparing the body physically increased feelings of control and subsequently reduced apprehension regarding surgery. Second, staff were concerned but trusted in a safe environment, describing how, despite staff's concerns regarding the risks of exercise in this population, the patients felt safe in their care whilst participating in an exercise programme in hospital. Third, rushing for recovery and the curious carer, where patients from both groups wanted to mobilise quickly postoperatively whilst staff visited patients on the ward to observe their recovery progress. Fourth, to survive and thrive postoperatively, reflecting staff and patients' expectations from the trial and what motivated them to participate. Fifth, benefits are diluted by lengthy waiting periods, reflecting the frustration felt by patients waiting for their surgery after completing the intervention and the fear about continuing exercise at home before they had been ‘fixed’. To conclude, functional exercise capacity may not have improved following prehabilitation in people before elective cardiac surgery due to concerns regarding the safety of exercise that may have hindered delivery and receipt of the intervention. Instead, numerous non-physical benefits were elicited. The information from this qualitative study offers valuable recommendations regarding refining a prehabilitation intervention and conducting a subsequent trial.


Publication metadata

Author(s): Harrison SL, Loughran KJ, Trevis J, Witharana P, Maier R, Hancock H, Bardgett M, Mathias A, Akowuah EF

Publication type: Article

Publication status: Published

Journal: Anaesthesia

Year: 2023

Pages: epub ahead of print

Online publication date: 04/07/2023

Acceptance date: 14/06/2023

Date deposited: 02/08/2023

ISSN (print): 0003-2409

ISSN (electronic): 1365-2044

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1111/anae.16082

DOI: 10.1111/anae.16082

PubMed id: 37402349


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Funding

Funder referenceFunder name
Heart Research UK
RG2671/18/20

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