ABSTRACT
Background: Surgery is the standard treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. We aimed to evaluate the implementation of a multimodal prehabilitation program in gastrointestinal cancer surgery patients. Method(s): Single-arm implementation trial using a pre-post study design. Colorectal or UGI cancer patients scheduled for curative intent surgery at Concord Hospital, with >=14 days pre-surgery were recruited. Intervention delivered face-toface or by telehealth (COVID adaptations): 2-4-week program consisting of: i) supervised exercise (minimum 1/week);ii) dietary education session and daily high protein supplement;iii) weekly nursing support. Assessments: baseline, pre-surgery, and 30-days post-surgery. Primary Outcome: implementation using RE-AIM (Reach/Efficacy/Adoption/Implementation/ Maintenance) framework. Secondary outcomes included functional capacity, nutritional and psychological status changes. Result(s): Total 198 were screened over 16 months;100 (51%) were eligible. Reach/representativeness: 77/100 recruited (64 colorectal, 13 UGI). Mean (SD) age 67 (12.4) years;46 (60%) males. Median intervention duration 16 days (IQR:8). Adoption: 91% (70/77) referrals directly from surgeons. Implementation: 72/77 completed the intervention (34% of assessments and intervention sessions delivered by telehealth). Five withdrew: psychological stress (n = 2), medical (n = 1), disease progression (n = 1), noncompliance COVID precautions (n = 1). Adherence to all modalities was 34% (64% exercise, 81% nutrition, 63% nursing). Adherence rate for 31/35 patients was affected by staff unavailability. Efficacy: Functional capacity (mean 6-minute walk test) change from baseline to pre-surgery 464.4-471.7m(p=.775);and baseline to after surgery 464.4 to 482m(p = .052). No significant changes were seen in nutritional and psychological outcomes. Patient satisfaction:96%strongly recommended prehabilitation. Clinician satisfaction was high. Conclusion(s): Our results show a brief prehabilitation intervention (exercise, nutrition, psychological support) can be successfully implemented in a real-world setting;with a trend to improvement in functional capacity. Prehabilitation is an opportunity to optimize patients' function before gastrointestinal cancer surgery.
ABSTRACT
Individual’s decision to cooperate with disease prevention varies based on their respective health beliefs and common factors that motivate actions. Previous research has found that pandemic anxiety, high health literacy, and eHealth literacy influenced healthcare behavior. Understanding how the pandemic affects people on modifying preventive health behavior is promising. Accordingly, this cross-sectional study focusing on health behavior utilized Structural Equation Modeling to characterize causative factors of anxiety, health literacy, eHealth literature, and protection in the new normal of COVID-19 pandemic in Thailand. Online surveys used a snowball sampling method through social media to recruit participants aged over 20 years in 8 provinces in Thailand. iGeneration and millennials were the top two, making up 75.0% of the 700-respondents in total. Independent variables: Health Literacy (p = .030);eHealth Literacy (p < .001);and anxiety (p = .040) significantly influenced the new normal. The new normal practices: hand hygiene, wearing hygienic masks and social distancing, maintaining good health, and preventing virus exposure by making digital payments could be indicated by 34% of Thai people by all those independent variables. This means that those who are more concerned and literate about health literacy and eHealth literacy, will make better health decisions and practice more preventive health care. Individuals may use health knowledge to make healthy decisions to protect themselves from the current pandemic. They can also use what they have learned to defend themselves from other emerging infectious illnesses in the future. Therefore, official institutions should provide helpful and timely health information that is easily accessible. Public health interventions should prioritize the availability of health information in the electronic form on various social media platforms to educate people to protect themselves from the spread of disease. The information should be comprehensible and practical for all socioeconomic groups. © 2022, Mahidol University - ASEAN Institute for Health Development. All rights reserved.