Professor Mike Grocott is Professor of Anaesthesia and Critical Care Medicine at the University of Southampton. Recently in September 2019 he spoke at the Royal College of Surgeon’s event in Cardiff on ‘Getting Patients Fit for Surgery’. Here he discusses the concept of ‘prehabilitation’ and shares some of his ‘top tips’ for helping patients to prepare themselves – physically and emotionally – for the rigours of undergoing an operation, to optimise their outcomes.
The way we care for people in the run up to surgery is on the cusp of a radical and transformational change. ‘Prehabilitation’ is coming to a hospital or community health centre near you. It involves encouraging patients to prepare for treatment, by adopting healthy behaviours and psychological interventions which match their individual needs. This may include stopping smoking and drinking, eating healthily and taking part in prescribed exercise under the supervision of an instructor, for a set amount of time before surgery.
Earlier this month, several hundred healthcare professionals, including oncologists, surgeons, nurses, allied health professionals and patients, attended the 3rd ‘World Congress of Prehabilitation’. The event, held at the British Museum, also saw the charity Macmillan Cancer Support, The Royal College of Anaesthetists and The National Institute of Health Research, launch a document entitled: “Principles and guidance for prehabilitation for people with cancer”. I would urge all health professionals involved in cancer care to read it. It sets out how we can help our patients to build up their resilience levels before facing the challenges of undergoing cancer treatment, and how we can help them achieve better health and fitness in the long term.
As Dr Fran Woodard from Support says in the guidance: “You wouldn’t run a marathon without undertaking any training and prehabilitation aims to optimise a person’s health and wellbeing to help maximise their resilience to treatment throughout their journey.”
We all aware of the vast and consistent literature linking physical fitness with better health outcomes across the whole spectrum of long-term conditions, from cancer and dementia, to heart disease and mental health. Good nutrition and psychological wellbeing are supported by similar literature.
And yet, typically, in our own lives, we struggle to achieve the behaviour change necessary to “walk this walk”. I think most of us would acknowledge that we wish that we could, but life, work, family, relationships and many other things in life seem to somehow get in the way of our best intentions.
Similarly, and possibly linked to this, we clinicians may not be the best at conveying messages about health behaviours to our patients. Nudge theory suggests that consistent and reliable “positive reinforcement” has the potential to shift behaviour, and that role modelling by health and care professionals has a huge role to play.
There is an arguably unique window of opportunity when someone is suddenly forced to contemplate a new and potentially life-threatening diagnosis, such as cancer. They are both scared and particularly focussed on their own health and the threats to it. This “teachable moment” offers an opportunity to intervene and change behaviours by working with patients to enable them to improve their own health.
In our clinics for cancer surgical patients in Southampton, I see how engaged patients become at the opportunity to take a proactive role in their illness, the empowerment that comes from them taking control of at least one aspect of their treatment and the delight in being able to contribute positively to their own care. The positive health outcomes of greater resilience to adverse treatment, improved recovery following treatment, and better long-term health are the icing on the cake.
The notion of “Making Every Contact Count” (MECC) with a patient is an approach to behaviour change based on day-to-day interactions between people to support them in making positive changes to physical and mental health and wellbeing. We all have a role in nudging patients (and perhaps ourselves and our colleagues) in this way.
If you haven’t heard about prehabilitation before, please get in touch with a local group who are doing this (they are highlighted in the “Prehab for people with cancer” document), or contact one of the stakeholder organisations for more details. And, don’t forget yourself. We will all be patients one day, and those little nudges all count.
- The Centre for Perioperative Care (CPOC) is a cross-specialty centre dedicated to the promotion, advancement and development of perioperative care. Professor Grocott is the Deputy Chair of its board. The centre is a new cross-organisational, multidisciplinary initiative led by the Royal College of Anaesthetists, with other professional stakeholders including Medical Royal Colleges (the Royal College of Surgeons is a partner), NHS England and the equivalent bodies responsible for healthcare in the other UK devolved nations.