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Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales

Jack Walklett, Alex Christensen, Charlotte N B Grey, Rachael C Barlow, Rhiannon McDonald, Alisha Davies, Esther Mugweni

BMC Health Services Research, Volume: 24, Start page: 1525

Swansea University Author: Alisha Davies

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DOI (Published version): 10.1186/s12913-024-11964-3

Abstract

Evidence suggests that prehabilitation interventions, which optimise physical and mental health prior to treatment, can improve outcomes for surgical cancer patients and save costs to the health system through faster recovery and fewer complications. However, robust, theory-based evaluations of thes...

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Published in: BMC Health Services Research
ISSN: 1472-6963
Published: Springer Nature 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa68576
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spelling 2024-12-17T11:44:35.6450196 v2 68576 2024-12-17 Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales 61637bbc7022463802bb0a8993c9bf71 Alisha Davies Alisha Davies true false 2024-12-17 Evidence suggests that prehabilitation interventions, which optimise physical and mental health prior to treatment, can improve outcomes for surgical cancer patients and save costs to the health system through faster recovery and fewer complications. However, robust, theory-based evaluations of these programmes are needed. Using a theory of change (ToC) approach can guide evaluation plans by describing how and why a programme is expected to work. Theories of Change have not been developed for cancer prehabilitation programmes in the literature to date. This paper aims to provide an overview of the methodological steps we used to retrospectively construct a ToC for Prehab2Rehab (P2R), a cancer prehabilitation programme being implemented by the Cardiff and Vale University Health Board. We used an iterative, participatory approach to develop the ToC. Following a literature review and document analysis, we facilitated a workshop with fourteen stakeholders from across the programme using a 'backwards mapping' approach. After the workshop, stakeholders had three additional opportunities to refine and validate a final working version of the ToC. Our process resulted in the effective and timely development of a ToC. The ToC captures how P2R's interventions or activities are expected to bring about short, medium and long-term outcomes that, collectively, should result in the overarching desired impacts of the programme, which were improved patient flow and reduced costs to the health system. The process of developing a ToC also enabled us to have a better understanding of the programme and build rapport with key stakeholders. The ToC has guided the design of an evaluation that covers the complexity of P2R and will generate lessons for policy and clinical practice on supporting surgical cancer patients in Wales and beyond. We recommend that evaluators apply a ToC development process at the outset of evaluations to bring together stakeholders and enhance the utilisation of the findings. This paper details a pragmatic, efficient and replicable process that evaluators could adopt to develop a ToC. Theory-informed evaluations may provide better evidence to develop and refine cancer prehabilitation interventions and other complex public health interventions. [Abstract copyright: © 2024. The Author(s).] Journal Article BMC Health Services Research 24 1525 Springer Nature 1472-6963 Theory of Change (ToC), Cancer Prehabilitation, Evaluation, Stakeholders, Complex Intervention 2 12 2024 2024-12-02 10.1186/s12913-024-11964-3 COLLEGE NANME COLLEGE CODE Swansea University Another institution paid the OA fee No funding was received for this work. 2024-12-17T11:44:35.6450196 2024-12-17T11:34:44.9276451 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Jack Walklett 1 Alex Christensen 2 Charlotte N B Grey 3 Rachael C Barlow 4 Rhiannon McDonald 5 Alisha Davies 6 Esther Mugweni 7
title Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales
spellingShingle Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales
Alisha Davies
title_short Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales
title_full Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales
title_fullStr Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales
title_full_unstemmed Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales
title_sort Co-developing a theory of change for a personalised multimodal cancer prehabilitation programme in South Wales
author_id_str_mv 61637bbc7022463802bb0a8993c9bf71
author_id_fullname_str_mv 61637bbc7022463802bb0a8993c9bf71_***_Alisha Davies
author Alisha Davies
author2 Jack Walklett
Alex Christensen
Charlotte N B Grey
Rachael C Barlow
Rhiannon McDonald
Alisha Davies
Esther Mugweni
format Journal article
container_title BMC Health Services Research
container_volume 24
container_start_page 1525
publishDate 2024
institution Swansea University
issn 1472-6963
doi_str_mv 10.1186/s12913-024-11964-3
publisher Springer Nature
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
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description Evidence suggests that prehabilitation interventions, which optimise physical and mental health prior to treatment, can improve outcomes for surgical cancer patients and save costs to the health system through faster recovery and fewer complications. However, robust, theory-based evaluations of these programmes are needed. Using a theory of change (ToC) approach can guide evaluation plans by describing how and why a programme is expected to work. Theories of Change have not been developed for cancer prehabilitation programmes in the literature to date. This paper aims to provide an overview of the methodological steps we used to retrospectively construct a ToC for Prehab2Rehab (P2R), a cancer prehabilitation programme being implemented by the Cardiff and Vale University Health Board. We used an iterative, participatory approach to develop the ToC. Following a literature review and document analysis, we facilitated a workshop with fourteen stakeholders from across the programme using a 'backwards mapping' approach. After the workshop, stakeholders had three additional opportunities to refine and validate a final working version of the ToC. Our process resulted in the effective and timely development of a ToC. The ToC captures how P2R's interventions or activities are expected to bring about short, medium and long-term outcomes that, collectively, should result in the overarching desired impacts of the programme, which were improved patient flow and reduced costs to the health system. The process of developing a ToC also enabled us to have a better understanding of the programme and build rapport with key stakeholders. The ToC has guided the design of an evaluation that covers the complexity of P2R and will generate lessons for policy and clinical practice on supporting surgical cancer patients in Wales and beyond. We recommend that evaluators apply a ToC development process at the outset of evaluations to bring together stakeholders and enhance the utilisation of the findings. This paper details a pragmatic, efficient and replicable process that evaluators could adopt to develop a ToC. Theory-informed evaluations may provide better evidence to develop and refine cancer prehabilitation interventions and other complex public health interventions. [Abstract copyright: © 2024. The Author(s).]
published_date 2024-12-02T05:49:21Z
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