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Psychological, social, and behavioral barriers and facilitators influence prehabilitation adherence in cancer patients before surgeryIdentifying what helps cancer patients start exercise before surgery

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Key Takeaway
Recognize the cognitive-behavioral gap where patients value prehabilitation but face barriers like low self-efficacy and scheduling.

This qualitative systematic review synthesized 20 studies to identify the psychological, social, and behavioral factors influencing prehabilitation before cancer surgery. The review identifies 7 categories of facilitating factors, including introduction mechanisms, value recognition, support systems, communication strategies, motivation and feedback, program design optimization, and process convenience. Conversely, 4 primary categories of barriers were identified: cognitive and informational barriers, individual factors, clinical process limitations, and implementation environment barriers.

Psychological facilitators include a regained sense of control, mood regulation, and altruistic motivation, while psychological barriers include fear, low self-efficacy, and illness-related distress. Socially, family involvement and peer support act as facilitators, while insufficient family support and communication gaps serve as barriers. Behaviorally, immediate progress feedback and self-monitoring facilitate participation, whereas scheduling conflicts and low exercise confidence act as barriers.

Clinicians should note the identified cognitive-behavioral gap where patients may recognize the value of prehabilitation but struggle with action due to low self-efficacy or logistical hurdles. The synthesis suggests that addressing these specific barriers through multi-level strategies, such as enhanced social support and behavioral reinforcement, may improve outcomes. The evidence is based on a qualitative synthesis of existing literature rather than clinical trials.

How this fits prior evidence

This systematic review addresses a gap in understanding the specific barriers to prehabilitation for cancer patients. While previous coverage has identified sparse direct data on cancer care barriers for immigrant workers, this review provides a broader qualitative synthesis of psychological and behavioral barriers for the general adult cancer population. It does not relate to the molecular mechanisms or genetic markers of cancer progression discussed in other covered topics.

Preparing the body for cancer surgery through prehabilitation can be a powerful way to build strength. However, many patients find it hard to actually start these programs. A review of 20 studies identified a gap where patients recognize the value of exercise but struggle with the practical and mental steps to begin.

Several factors make it easier for patients to stay on track. These include having a strong support system, clear communication from doctors, and getting immediate feedback on their progress. Social support from family and peers, along with a sense of personal control, also helps patients feel more capable.

On the other hand, some hurdles stand in the way. These include fear, low confidence in their ability to exercise, and scheduling conflicts. To help more people succeed, the findings suggest that programs need to focus on building patient confidence and providing better social support to bridge the gap between wanting to improve and actually doing it.

What this means for you:
Support systems and clear feedback help cancer patients overcome fears and hurdles to start pre-surgery exercise.

Common questions

What makes it easier for cancer patients to start exercise?

Several factors help patients start and stay with exercise. These include having a strong support system, clear communication from staff, and getting immediate feedback on their progress. Social support from family and peers, along with a sense of personal control and better program design, also help patients feel more motivated.

What are the main challenges patients face before surgery?

Patients often face psychological barriers like fear and low confidence in their ability to exercise. They may also face social barriers like a lack of family support or communication gaps. Practical issues, such as scheduling conflicts and a lack of clear information, can also make it hard to start.

How can programs be improved for these patients?

To help patients overcome the gap between wanting to exercise and actually doing it, programs should focus on building self-efficacy, providing better social support, and offering clear behavioral reinforcement. This means making the program easier to access and providing more consistent feedback to the patient.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BackgroundPrehabilitation before cancer surgery improves postoperative outcomes, yet patient participation remains suboptimal. This qualitative systematic review aimed to synthesize psychological, social, and behavioral barriers and facilitators to preoperative prehabilitation among adult cancer patients.MethodsA systematic search was conducted in CNKI, Wanfang Data, CBM, VIP, PubMed, Web of Science, The Cochrane Library, Embase, and CINAHL from inception to January 13, 2025, with an updated search on May 31, 2025. A total of 1,184 articles were screened, and 20 qualitative studies were included. Quality appraisal was performed using the Critical Appraisal Skills Programme (CASP). Thematic analysis was employed for data synthesis.ResultsThe analysis identified 7 facilitating factors: (1) Introduction Mechanisms, (2) Value Recognition, (3) Support Systems, (4) Communication Strategies, (5) Motivation and Feedback Mechanisms, (6) Program Design Optimization, and (7) Process Convenience and Program Accessibility, and 4 barrier factors: (1) Cognitive and Informational Barriers, (2) Individual Factors, (3) Clinical Process Limitations, and (4) Implementation Environment Barriers. When mapped onto a psychological, social, and behavioral framework, psychological facilitators included regained sense of control, mood regulation, and altruistic motivation; psychological barriers encompassed fear, low self-efficacy, and illness-related distress. Social facilitators comprised family involvement, peer support, and professional encouragement; social barriers included insufficient family support and communication gaps. Behavioral facilitators were driven by immediate progress feedback and self-monitoring; behavioral barriers included scheduling conflicts and low exercise confidence.ConclusionThis synthesis reveals a persistent “cognitive-behavioral gap”—patients recognize the value of prehabilitation yet encounter barriers that prevent them from translating this recognition into sustained action. Addressing this gap requires integrated, multi-level strategies that enhance self-efficacy, mobilize social support, embed behavioral reinforcement mechanisms, and address systemic barriers.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420250650240.
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