Patients' Perspectives on a Multidisciplinary Preparation Program Before Head and Neck Reconstructive Surgery

This is a multimodal prehabilitation (PREHAB) program for patients undergoing free flap reconstruction for head and neck cancer. The intervention is designed to evaluate the acceptability of a screening pack and a universal patient diary intended for future use within a prehabilitation pathway. The intervention comprises two components: 1. PREHAB Screening Pack The screening pack contains validated screening instruments designed to identify patients' baseline health status and supportive care needs across multiple prehabilitation domains. The screening tools include: i. Malnutrition Screening Tool (MST): assesses recent unintentional weight loss and reduced appetite to identify risk of malnutrition. ii. Eating Assessment Tool-10 (EAT-10): assesses patient-reported swallowing difficulties and symptoms suggestive of dysphagia. iii. International Physical Activity Questionnaire – Short Form (IPAQ-SF) assesses physical activity levels and sedentary behaviour over the previous seven days. iv. Charlson Comorbidity Index (CCI): assesses medical comorbidities and overall disease burden. v. Clinical Frailty Scale (CFS): assesses baseline frailty, functional status and independence prior to surgery. vi. Distress Thermometer: screens for psychological distress and identifies patients who may benefit from psychosocial support. These validated tools were selected to represent the key domains of multimodal prehabilitation, including nutrition, swallowing, physical activity, comorbidity, frailty and psychological wellbeing. 2. Universal PREHAB Patient Diary The universal patient diary was developed specifically for this study by the research team in consultation with the multidisciplinary PREHAB working group. It is a prototype resource designed to support patient education and future self-management within a prehabilitation pathway. The diary contains structured educational content covering nutrition, swallowing, exercise, oral health and psychosocial wellbeing, together with example weekly prompts, self-monitoring sections and links to evidence-based educational resources. The educational resources referenced within the diary are existing publicly available resources from organisations including Cancer Council Australia, Quitline, the National Health and Medical Research Council (NHMRC), PREP4Cancer, Cancer Mind Care, and existing hospital-developed nutrition, speech pathology and oral health resources. The overall diary structure, integration of these resources, weekly prompts and reflection sections were developed specifically for this study. Participants are provided with the screening pack and universal patient diary during their pre-admission appointment, approximately 2 weeks post-surgery. Participants are not asked to complete the screening questionnaires or the patient diary as part of this study. Instead, they are asked to review both resources and provide feedback regarding their content, clarity, relevance, usability, comprehensiveness and perceived usefulness. They are specifically invited to comment on whether the screening tools appear appropriate for identifying prehabilitation needs and whether the diary would be useful and acceptable for patients preparing for surgery. The study does not involve the delivery of a clinician-led prehabilitation intervention, nor are participants expected to undertake any of the educational activities, weekly prompts, goal-setting exercises or self-monitoring tasks contained within the diary. These materials are presented solely for review to obtain participant feedback that will inform refinement of the PREHAB resources prior to future implementation.