Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the Autologous Stem Cell Transplant population: A theory-based interview study

Abstract: Purpose Health care professionals (HCP) play a vital role in effectiveness of prehabilitation programs, but information is limited about what assists HCP deliver an effective service. This study evaluated HCP perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to autologous stem cell transplant. Methods Based on the Theoretical Domains Framework (TDF) of behaviour change, we conducted semi-structured interviews, purposively sampling 14 participants (from various healthcare disciplines) at a tertiary cancer centre. Discipline-specific topic guides were created based on the TDF and the behaviours appropriate to each discipline. Interviews were audio-recorded, transcribed verbatim, anonymised, content analysed (grouping, then labelling, thematically similar responses) and classified into theoretical domains. Structured decision rules were used to classify themes as high, medium or low priority. Results Fifty enablers and 31 barriers were identified; of these 26 enablers and 16 barriers classified as high priority. Four domains had the most frequent high-priority enablers: Social professional role and identity (e.g., multidisciplinary teamwork); Beliefs about consequences (e.g., patient benefit); Memory, attention and decision processes (e.g., refer as early as possible); and Environmental context and resources (e.g., electronic medical records are beneficial). High-priority barriers were most frequent in four domains: Memory, attention and decision processes (e.g., conflicting views about who should be referred); Environmental context and resources (e.g., lack of time); Social influences (e.g., families); and Emotions (e.g., patient distress). Conclusion Participants reported more enablers than barriers. Findings can support delivery of prehabilitation programs in hospital settings where uptake remains low.