Prehabilitation is medical care, and it’s important to consider these interventions that are appropriately delivered at the right time in the right dose to the right patient.
One of the issues at this time is that most patients with cancer don’t have baseline assessments done for physical, cognitive, and functional status. Distress screening is often not done as a baseline. Therefore, even if prehabilitation is recommended, there is no way to really determine how much it’s helped the patient. Prehabilitation should be driven by outcomes that start with baseline assessments that are repeated in an effort to determine how well the interventions worked.
Prehabilitation in patients with cancer is relatively new, and it’s important to conduct research to test what works or doesn’t. Prehabilitation shouldn’t be regarded as something that is one size fits all or works for everyone. The many potential barriers include patients feeling overwhelmed around the time of diagnosis and the interventions not being ideally individualized to a specific patient.
Addressing psychological distress is another component of prehabilitation baseline testing. One of the things to understand about distress is that it is frequently very high around the time of diagnosis and often increases just prior to surgery or another initial treatment. Therefore, a realistic goal of prehabilitation may not be to decrease distress if the anticipated trajectory is upward. Instead, it may be that distress increases no matter what, but with prehabilitation it increases less than it would without psychological interventions.
The conversation should be focused on how prehabilitation may help the individual patient and should be backed by data and evidence. Patients need to trust that the interventions their healthcare providers are recommending have been vetted and an evidence base supports them or at least they are considered best practices.
Nurses can use assessment tools to document the baseline status of patients recently diagnosed with cancer. Many of the tools involve patient-reported outcomes such as distress screening using a visual analog scale, discomfort screening using the Brief Pain Inventory, and upper-quadrant screening using the Quick DASH [Disabilities of the Arm, Shoulder, and Hand].