PREsurgery thoughts – thoughts on prehabilitation in oncologic gynecologic surgery, a qualitative template analysis in older adults and their healthcare professionals

Figures & data

Table 1. Interview themes.

Themes	Questions
Recovery after surgery^a	What, do you think, contributes to your recovery after surgery? What is your own part in recovery?
Preoperative period^a	How do/did you experience the period before surgery?
Thoughts on prehabilitation	What are your thoughts and expectations about prehabilitation? What do you think is the benefit of prehabilitation?
Motivation for prehabilitation	What would make you adhere to prehabilitation?^a What would motivate/stop you to refer patients for prehabilitation/to lead the program?^b
Feasibility	How do you see the feasibility of prehabilitation? What makes prehabilitation feasible? What are potential barriers?
Form of the program	How would the program be ideal for you? What is the most/least important? How much time may the program take? What kind of exercises are suitable? What kind of nutritional adaptations are suitable? What other kind of interventions are needed (for example smoking cessation, psychological support)? How do you see your own role in prehabilitation?^b
Support^b	What kind of support do you need to refer/treat patients? How could you support patients following the program?
Planning	Is it acceptable for you to postpone surgery to facilitate prehabilitation? How long can we postpone surgery?

^aOnly asked patients; ^bOnly asked healthcare professionals.

Figure 1. Flowchart of recruitment, sampling, and saturation of patients.

Figure 2. Flowchart saturation of healthcare professionals.

Table 2. Factors that could have a positive or negative effect on different aspects of prehabilitation.

Positive	Negative
Motivation	Practical barriers
Motivational reasons	Practical barriers for patients
Patient feels urgency	Short time period between diagnosis and operation
Patient can contribute to own recovery	Going to hospital for prehabilitation
Distraction from negative thoughts	Too intensive program
	Referral to another hospital
Motivational support
Individual	Practical barriers in organization
• Individual approach
• Seeing good results	Financial objections
• Setting goals	Capacity of space / personnel
• Activity tracker / pedometer	Much asked of gynecologist
	Poor communication between healthcare professionals
Support of others	Lack of knowledge / motivation by gynecologists
• Supervision and motivation by a professional	Implementing something new is difficult
• Support of family and friends	Lack of an evidence based program
• Specialist involved in prehabilitation	Patient related factors
• Doing it together with others	Stressful period for patients
• “Big stick” (like going somewhere)	Physical condition of patient
	Lack of knowledge by patients
Practical facilitators	Lack of motivation by patients
Prehabilitation part of routine	Nature/fixed patterns of patients
Motivated team	Patient dependent of care
	Limited access to digital resources
	Language barrier
	Confronting for patients

Boldface: only mentioned by patients; Italic: only mentioned by healthcare professionals.

Figure 3. Outline of the process of a prehabilitation program according to our participants. An interactive version of this figure with extra information on ideas per discipline within a prehabilitation program is available, see Supplemental material D (For the best interactive experience of Supplement D, please save and open the file with adobe.).