Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study
Authors: Raichurkar Pratik , Denehy Linda , Solomon Michael , Koh Cherry , Pillinger Neil , Hogan Sophie , McBride Kate , Carey Sharon , Bartyn Jenna , Hirst Nicholas , Steffens Daniel ,   Prehabilitation Expert Collaborative, Allen Jonathan , Ancog Kevin , Angenete Eva , Ansari Nabila , Ausania Fabio , Beaumont Anna , Beilstein Christian , Berrevoet Frederik , Boden Ianthe , Bostock Kimberley , Bothe Janine , Brandstrup Birgitte , Brennan Louise , Brown Kilian , Burden Sorrel , Burgess Crystal , Burns Elaine , Carli Francesco , Cavalheri Vinicius , Ceelen Wim , Chesney Tyler , Clark David , Clifford Kari , Cole Kelcie , Collyer Thomas , Copeland Rob , Croner Roland , Crowe Jess , Daniels Ian , Danjoux Gerard , Davis June , Davis Caitlin , de Klerk Mayke , Decorte Tina , Dekker Jan Willem , Denys Andreas , Desender Liesbeth , Dries Pieter , Dunne Declan , Edbrooke Lara , Edgar Linda , Eissa Sabry , Engel Dominique , Evans Martyn , Farrell Rhonda , Finch Alice , Fleury Aisling , Forget Patrice , Francis Nader , Frizelle Frank , Frontera Walter , Geboes Karen , Giddings Hugh , Gillespie Chris , Gillis Chelsia , Glehen Olivier , Gorey Varsha , Granger Catherine , Greenfield Diana , Griffiths Ben , Grimmett Chloe , Hackett Claire , Hall Travis , Hallet Julie , Harris Craig , Hatcher Sophie , Hendriks Lizza , Hermans Mendy , Ilyas Carl , Ismail Hilmy , Jenkins John , Jiang Wilson , Johnstone Charlotte , Karakatsanis Andreas , Karunaratne Sascha , Kaur Simarjit , Kelly Michael , Klaase Joost , Kršul Dorian , Leslie Scott , Loeliger Jenelle , Lydrup Marie-Louise , Maier Andrea , Major Piotr , Makker Preet , Mantyh Christopher , McCluskey Stuart , McGarrity Laura , Moloney Jayson , Montroni Isacco , Moran Brendan , Morris Paul , Moug Susan , Ms Rajeswari , Murdoch Sandra , Myers Anna , Ng Kheng-Seong , Nilsson Per J. , Noordzij Peter , O’Connor Mike , Pellino Gianluca , Philp Shannon , Pocard Marc , Puthucheary Zudin , Putrus Emma , Quyn Aaron , Read Thomas , Ricketts William , Riedel Bernhard , Rutten Harm , Sabajo Charissa , Salihi Rawand , Sammour Tarik , Sandroussi Charbel , Mina Daniel Santa , Saric Stefan , Sebio Raquel , Seyfi Doruk , Singh Favil , Slooter Gerrit , Smart Neil , Spencer Lissa , Sutton Paul , Tan Hao Ern , Cate David Ten , Turna Akif , Van Daele Elke , van den Berg Adinda , van Kessel Charlotte , van Ramshorst Gabrielle , Verdaasdonk Emiel , Vu Jennifer , Wakeman Chris , West Malcolm , Wheeler James , Wijeysundera Duminda , Yano Hideaki 
Published: August 2023

Abstract
Background
Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery.

Methods
The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority.

Results
A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery.

Conclusions
This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.