Healthcare professionals identified high immediate costs as an implementation barrier to pancreatic-cancer prehabilitation, with 71% (84 of 118) selecting that concern in the survey. They also pointed to obstacles for people taking part: 70% (84 of 120) identified symptoms as an engagement difficulty, while 64% (77 of 120) identified information overload.
What the survey asked
The mixed-methods cross-sectional survey set out to explore professionals' views on what could help or hinder implementation and engagement. It reported 138 respondents. The survey combined closed-text and open-text responses. Open-text responses were analyzed using reflexive thematic analysis to draw out themes about implementation facilitators and barriers.
Responsibility starts with the whole team
A clear organizational preference was shared responsibility. Eighty-five per cent (109 of 128) said organizing prehabilitation should be the responsibility of the entire multidisciplinary team. At the same time, 47% (60 of 128) said the NHS trust should be responsible for organizing it. Together, the responses show that respondents saw both the full clinical team and the NHS trust as relevant to organizing the service.
People and guidance matter
Respondents also pointed to the value of dedicated leadership and training. Dedicated prehabilitation champions were identified as facilitators, and 84% (101 of 120) supported specific training for relevant professionals. The survey also found strong support for practical guidance: 85% (102 of 120) considered specific implementation guidance developed alongside patients a key facilitator.
Access was part of that practical picture. Respondents emphasized equitable access and proposed community support and local facilities to improve accessibility and reduce burden. Their suggestions place access alongside organizational issues as part of the implementation challenge.
The barriers patients face
For patient engagement, the survey highlighted three different kinds of difficulty. Symptoms were identified by 70% (84 of 120), information overload by 64% (77 of 120), and lack of awareness of prehabilitation benefits by 62% (74 of 120). Together, those responses describe a challenge involving both what patients are experiencing and what they know about the possible benefits.
Earlier, more tailored support
Respondents favored an approach built around the individual. Patient empowerment was viewed as beneficial by 86% (104 of 121), individualized programmes were considered key by 80% (97 of 121), and 82% (99 of 121) said specific goals and targets would facilitate engagement. The preferences point to programmes that give patients a stronger role while setting clear, personal objectives.
Timing and coordination also drew broad support. Eighty-seven per cent (105 of 121) thought early implementation would facilitate engagement, and 88% (106 of 121) felt appointments should be combined on the same day. An opt-out referral model was also suggested as another way of organizing access.
A picture with clear limits
The authors caution that the findings cannot be treated as a complete picture of the workforce. They say the results are not generalizable to all clinical specialties and may be biased toward professionals already active in or interested in prehabilitation. The survey therefore offers a view of perceived facilitators and barriers among its respondents, rather than a representative account of every specialty.
The research was supported by the National Institute for Health Research Applied Research Collaboration North West Coast under grant NIHR-INF-2218. Supporting data are not publicly available because participants did not provide written consent for public data sharing.
Paper data and sources
Original title: Exploring facilitators and barriers to the implementation of prehabilitation for individuals with pancreatic cancer: a survey of healthcare professionals.
Authors: Elizabeth Wrench, Elizabeth McGladrigan, Robert M Lauder et al.
Journal/Repository: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s00520-026-11097-9
Original paper · Full text