Authors: Quinn Gerber, Lucas Carpenter, Jacob Clemons, Cindy Kin
Mentors: Cindy Kin
Insitution: Brigham Young University
Introduction: It is vital that patients are adequately prepared for surgical intervention. To meet this need, many medical centers have adopted prehabilitation protocols. The aim of this study was to establish an in-depth comprehension of the attitudes towards surgery and barriers
and preferences to prehabilitation for patients identifying as Latino, in order to develop a preliminary framework for adapting prehab programs to best meet the needs of this specific patient population.
Methods: We conducted qualitative semi-structured in-person one-on-one interviews with Latino patients who had recently undergone major abdominal surgery. The interviews, conducted at an academic medical center, were audio-recorded, transcribed verbatim, translated into English (as needed), iteratively coded, and discussed by four researchers to reach consensus. We used thematic analysis to identify shared attitudes held by patients and common barriers to the adoption of prehabilitation programs. Analysis of these attitudes and barriers, along with stated patient preferences, led to the development of several ideas that physicians can implement to increase prehab adoption among Latino patients.
Results: We interviewed 16 patients, at which point we reached thematic saturation. The patients were on average 52 years old (range 20 to 79) and 50% were women. Our pooled kappa score was .92, indicating a very high degree of concordance among the coding researchers. We identified five common attitudes held by Latino patients regarding surgery: anxiety associated with hospitalizations and surgical procedures, deep trust in physicians, reliance on positivity, tight-knit families/communities, and prominent religious and cultural beliefs. A lack of understanding, physical limitations, a reactive/delayed approach to healthcare, dietary barriers, and mental barriers emerged as obstacles to prehabilitation adoption. These attitudes and barriers, along with direct patient feedback, led us to identify several programmatic priorities that may increase adherence to prehab. These components consist of face-to-face interaction, increased communication, patient and physician collaboration in program development, and family/support group engagement in surgical preparation.
Conclusion: Our study provides physicians preliminary insight into customizing prehabilitation programs to best meet the needs and customs of the Latino community, including anxiety associated with hospitalizations, strong social support, and a dominant role of religious faith in coping with illness. We identified several critical components that may make prehab more culturally competent and thus more likely to be adopted by patients. These include in-person coaching, increased information about the upcoming operation and recovery, and engagement of family members. We recommend that healthcare teams committed to prehabilitation consider these needs to make their programs more attractive and accessible to their Latino patients.