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

by Sophie Stanley, Hilary Stewart, Cliff Shelton

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.

Randomised controlled trial of VR-based observation meditation with AI coaching ('Otti) for stress reduction in university students in the United States: study protocol

Introduction

Stress is a major health issue in contemporary society, and mindfulness-based approaches reduce stress and anxiety but face practical barriers to consistent practice; this protocol evaluates a Virtual Reality (VR)-based observation meditation programme with an artificial intelligence (AI) coach (‘Otti’) that delivers real-time empathic, tailored prompts to support present-focused attention and emotion regulation in university students in the United States. A single-centre randomised controlled trial in Pennsylvania will assess immediate psychophysiological effects and user acceptability after a single 15 min session following a standardised Stroop stressor in a university laboratory setting.

Methods and analysis

An a priori power analysis (f=0.25, α=0.05, power=0.80) supports recruitment of 34 students (n=17 per group) in a single-centre randomised controlled design comparing AI-coached VR observation meditation to a no-treatment leisure control within a 30 min visit. Participants complete pre-intervention surveys Perceived Stress Scale-10 (PSS-10), Depression Anxiety Stress Scales (DASS-21), State–Trait Anxiety Inventory (STAI-State, STAI-Trait) and baseline heart rate/Heart Rate Variability (HRV) via smartwatch, undergo the 15 min intervention or control, then complete postintervention surveys and repeated heart rate/HRV recording; effects will be tested using repeated-measures analysis of variance, with heart-rate data exported and preprocessed per the prespecified plan. Primary outcomes include perceived stress (PSS-10), emotional state (DASS-21, STAI-State, STAI-Trait), physiological stress response (heart rate/HRV) and participant satisfaction via a structured postintervention survey (usability, perceived effectiveness, comfort).

Ethics and dissemination

The study received IRB approval from The Pennsylvania State University Institutional Review Board (PSU CATS IRB: STUDY00025978; ClinicalTrials.gov: NCT06704282), and all participants will provide written informed consent prior to procedures. Findings will be disseminated via open access publication, conference presentations and stakeholder-focused briefs, with an anonymised primary-outcome dataset available on reasonable request in line with BMJ Open policies and Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)/International Committee of Medical Journal Editors (ICMJE) guidance.

Trial registration number

NCT06704282.