Improving equity in prehabilitation before cancer surgery: consensus-based considerations for leaders and practitioners: a nominal group technique study.

Prehabilitation aims to improve physical, nutritional and psychological health before surgery. Despite its potential benefits, inequitable access remains a concern. The wider PARITY study aimed to identify and help address inequalities in prehabilitation before cancer surgery using a mixed-methods approach. This report describes the end-of-study prioritisation workshop, which brought together professional, public and patient participants to prioritise considerations to promote equity in prehabilitation services using a nominal group technique. Before the workshop, 42 considerations identified from preceding work, including co-design, Delphi, service mapping and case studies, were shared with participants for review. Participants (n = 15) discussed and prioritised these considerations according to perceived impact and feasibility of implementation. Considerations were ranked by perceived priority and categorised by level of implementation. Forty-two considerations were prioritised and categorised as system level (n = 15), service level (n = 22) and practitioner level (n = 5). The six highest-priority considerations relate to: understanding how prehabilitation and surgery may affect each patient's life; adapting delivery to individual needs; making services available at a system-wide level; contacting patients who are not engaging; providing interpreters where needed; and training care teams in equality and diversity issues. These findings provide consensus-based considerations to support more equitable prehabilitation before cancer surgery, at a time when prehabilitation is increasingly prominent in national guidance.