Promoting or pressurising participation? : A discourse analysis of online patient information resources about prehabilitation before cancer treatment

Stanley, Sophie and Stewart, Hilary and Shelton, Cliff (2025) Promoting or pressurising participation? : A discourse analysis of online patient information resources about prehabilitation before cancer treatment. PLoS One, 20 (12): e0339169. ISSN 1932-6203

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Abstract

Prehabilitation aims to improve outcomes by optimising health before treatment. Interventions typically target diet, physical activity and/or mental health. Communicating the benefits of prehabilitation may influence patients’ engagement in interventions. However, the evidence for prehabilitation prior to cancer treatment is replete with uncertainties. Synthesising and communicating the efficacy of prehabilitation is challenging. This study aims to understand how evidence, motivation and accessibility are balanced in online patient-facing resources about prehabilitation. Databases, search engines and websites (identified by prehabilitation researchers) were systematically searched for patient-facing resources from UK organisations about prehabilitation before cancer treatment. Search strategies were built from non-technical synonyms for three terms: prehabilitation, cancer, and patient information. Results were screened against predefined eligibility criteria. The Quality Evaluation Scoring Tool assessment informed purposive sampling. Included resources were interrogated using discourse analysis. Screening of 3394 search results identified 68 resources from which a sample of 25 was analysed. Two themes summarised how resources presented prehabilitation to patients. Resources influenced rather than informed patients about participation in prehabilitation. Benefits were presented with emphasis, certainty and authority whereas limitations or alternatives were rarely discussed. The information focused on individual motivation rather than acknowledging patients’ resources or systemic barriers. Overall, it functioned to convince patients to participate in prehabilitation. Promoting prehabilitation in patient-facing literature may be beneficial. However, this relies upon two assumptions: firstly, that this communication approach is effective at increasing participation in practice, and secondly, that prehabilitation itself is ‘beneficial’. When outcomes prioritised by patients are not established, and evidence remains uncertain, this is not guaranteed. Overpromoting the benefits of prehabilitation risks giving patients unrealistic expectations. Allocating responsibility to individuals may risk introducing patient blame and guilt in the event of treatment complications. Further research is required to understand how patients experience information resources and to define the patient-centred outcomes of prehabilitation.