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Publications

Journal Article Ahead of print

PubMed: 42639917 DOI: 10.1080/09638288.2026.2720764

Patient perspectives on adherence to a virtual multimodal (P)REHABILITATION program in gastrointestinal cancer: a theory-driven qualitative behavioural analysis.

Disabil Rehabil

Authors: Annie Zhou, Haryana M Dhillon, Cherry Koh, Allan Ben Smith, Helen Mohan, Sharon Carey, Stephen Smith, Thomas Poulton, Vicki Patton, Kate White, Liliana Laranjo, Mbathio Dieng, Xiaoqiu Liu, Linda Denehy, Kate Wilson, Margaret Allman-Farinelli, Phyllis Butow, Bernhard Riedel, Rachael L Morton, Leanne Hassett, Qiang Li, Kim Delbaere, Owen Hutchings, Olivia Martin, Briana Shailer, Gaynor Beardsworth, Marine Salter, Kathryn Cherry, Freya Rubie, Lauren Reece, Aveline Chan, Rihan Shahab, Olivia Dwyer, Kaylene Pring, Derek Cunningham, Kym Sheehan, Gino Iori, Rika Johnander, Claire Jeon, Jack Reeves, Nicholas Hirst, Sascha Karunaratne, Michael Solomon, Daniel Steffens

Affiliations

  • Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.
  • Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.
  • Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
  • The Daffodil Centre, The University of Sydney, and Cancer Council NSW, Sydney, NSW, Australia.
  • Department of Cancer Surgery, Melbourne, VIC, Australia.
  • Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.
  • Department of Colorectal Surgery, John Hunter Hospital, Sydney, NSW, Australia.
  • Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
  • Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
  • Faculty of Health Sciences, Curtin School of Nursing, Curtin University, Perth, WA, Australia.
  • Cancer Care Research Unit, Susan Wakil School of Nursing, The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, NSW, Australia.
  • Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia.
  • NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
  • Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
  • Department of Physiotherapy, Department of Health Services and Implementation Science, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, VIC, Australia.
  • The Sir Peter MacCallum Department of Oncology, Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
  • Sydney Health Partners, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
  • Falls, Balance and Injury Research Centre, Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.
  • School of Health Sciences, University of New South Wales (UNSW), Sydney, NSW, Australia.
  • RPA Virtual Hospital (RPA Virtual), Sydney Local Health District, Sydney, NSW, Australia.
  • Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • Cancer Voices NSW, Sydney, NSW, Australia.
  • Discipline of Physiotherapy, School of Human Performance, Rehabilitation, and Population Health, Faculty of Health, University of Technology, Sydney, NSW, Australia.

Abstract

PURPOSE

This qualitative study explored barriers and facilitators to adherence among participants of a virtual multimodal (p)rehabilitation program for gastrointestinal cancer surgery and investigated how these aligned with constructs from Temporal Self-Regulation Theory (TST), a theoretical behaviour change framework.

MATERIALS AND METHODS

Semi-structured interviews were conducted with participants of the PRIORITY-CONNECT 2 Pilot Trial, a virtual multimodal (p)rehabilitation program for patients undergoing major gastrointestinal cancer surgery. TST informed the development of the semi-structured interview questions to explore participants' experiences of barriers and facilitators to uptake of the program recommendations. Reflexive thematic analysis was conducted to identify patterns within participants' experiences and perceptions of the (p)rehabilitation program.

RESULTS

13 interviews were conducted. Six themes were identified: (1) Trust in Healthcare Professionals; (2) Overall Program Perceptions; (3) Socioenvironmental Impacts; (4) Personal Characteristics and Motivation; (5) Prior Health Habits; (6) Symptoms Impacting Physical Capacity. These themes mapped to the constructs of TST, identifying how beliefs about program value, contextual barriers, and self-regulatory capacity shape adherence behaviour.

CONCLUSIONS

Adherence to virtual (p)rehabilitation was influenced by trust, perceived benefit, and flexible, supervised delivery, but limited by competing demands and treatment-related fatigue. Integrating behaviour-change principles from TST may enhance adherence in future multimodal (p)rehabilitation programs.

MeSH

Patient Compliance, Neoplasms, Rehabilitation, Gastrointestinal Neoplasms, Disabled Persons