Expert Consensus on Self-Reported Physical, Nutritional, and Psychological Screening Tools for Prehabilitation in Gastrointestinal Cancer Surgery: An International Delphi Study
Prehabilitation can decrease postoperative complications and enhance recovery for people with gastrointestinal cancer. Preoperative screening may identify individuals at highest risk of poor postoperative outcomes, enabling targeted and tailored interventions. Despite this, optimal tools for screening patients before surgery remain unclear. This Delphi study sought to achieve international consensus on appropriate screening tools to identify patients at increased risk of postoperative complications before undergoing gastrointestinal cancer surgery. A three-round iterative Delphi survey was distributed to a global multidisciplinary network of prehabilitation experts. Respondents were asked to rate screening tools, identified through a scoping review, on a 5-point Likert scale based on the appropriateness of their use for adult patients undergoing gastrointestinal cancer surgery. The screening tools were categorized as evaluating either physical, nutritional, or psychological domains. A consensus criterion was applied in the second and third rounds, which required ≥ 70% of respondents to rate a given tool as ≥ 4 for it to proceed to future rounds. Overall, 308 self-nominated prehabilitation experts rated the screening tools. Of 26 screening tools (including 9 physical, 7 nutritional, and 10 psychological), consensus was achieved for three physical, three nutritional, and four psychological tools. Based on Delphi consensus of global prehabilitation experts, 10 self-reported screening tools reached consensus. Given that tool selection was informed by Delphi consensus rather than empirical validation, prospective studies are necessary to assess whether these instruments accurately stratify surgical risk and identify candidates most likely to benefit from prehabilitation.