‘Inclusive Prehabilitation’ Project Shows Promise for Tackling Inequity in Cancer Care Across Wales

A major three-year research project led by Cardiff University has found that a new educational approach – Inclusive Prehabilitation (I-Prehab) – can strengthen cancer care workers’ confidence and knowledge in supporting people from all backgrounds to prepare for cancer treatment.

The research, delivered in partnership with Aneurin Bevan University Health Board, University of Sussex, Swansea University, and the National Cancer Team, set out to address long-standing inequalities in access to cancer prehabilitation among people from areas of socioeconomic deprivation and minority ethnic groups.

Cancer prehabilitation helps people to improve physical activity, nutrition and emotional resilience before treatment begins. Evidence shows that people who are better prepared experience fewer complications and better outcomes. Yet, as the study confirmed, only around 14% of cancer patients in Wales currently access prehab services, with those from disadvantaged backgrounds significantly under-represented.

The I-Prehab project combined a systematic review of existing research, observation of NHS services nationwide, extensive patient and public involvement, and pilot testing of a newly-developed online education package for cancer care workers. More than 40 members of the public contributed through a Patient Advisory Group and wider I-Prehab Community, ensuring diverse voices shaped the priorities and content of the education.

Researchers saw 120 prehab sessions, interviewed patients, carers and cancer care workers, and analysed 136 anonymised patient records. They found key barriers to engagement – including communication challenges, limited tailoring of support, and inconsistent service design. They also found people would be encouraged to take part with more person-centred care and strong social support.

These insights informed the creation of six interactive online learning modules for cancer care workers covering topics such as getting to know the person with cancer, engaging them effectively, and making services and resources inclusive. In the final phase of the project, 78 cancer care workers completed the training. Knowledge scores rose from an average of 7 to 9 out of 10, and confidence in communicating with patients also increased substantially. Seventy-two per cent reported a moderate or significant impact on their practice, with many intending to adopt more personalised and inclusive approaches.

This research shows that online education can be successfully delivered at scale and may help reduce inequities in cancer care. Further research is now needed to figure out whether I-Prehab education improves patient engagement, reduces treatment complications and offers value for money across the NHS.

The I‑Prehab education package is freely available in English and in Welsh.

Note. Funded by The National Institute for Health and Care Research (NIHR), Health and Social Care Delivery Research Programme (Award ID: NIHR151668). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.