From Treating to Preventing Distress through Psychological Prehabilitation – A Novel Theoretical Framework
Year: 2026
Type: preprint
Abstract: Background: In cancer prehabilitation, physical components predominate and psychological preparation is often overlooked. Yet up to half of patients develop distress during treatment, which undermines adherence, recovery, and quality of life. Psychological care remains largely reactive and lacks a unifying theoretical framework for prevention. Preventing distress poses three challenges: building resilience; doing so before patients have experienced treatment stressors; and tailoring this to each patient.Methods: Following conceptual review guidance, we selected theories that address these challenges and integrated them into one framework.Results: We synthesised five theoretical traditions (stress and resilience, social identity, affective forecasting, stress inoculation, and narrative identity) into four areas for assessment and intervention, framed as questions for the patient. What do I bring? covers beliefs about illness and treatment, coping and emotion regulation, and social support and group memberships. Where am I heading? covers how patients expect treatment to feel, including underestimating their ability to adapt. What do I need? uses stress inoculation to build and rehearse coping, with imagery for stressors that cannot be simulated. Who am I (becoming)? links these through the patient's personal story, from past coping to future recovery. The framework specifies testable mechanisms; for example, limited resources and skewed forecasts may predict distress during treatment. It maps onto universal, targeted, and specialist levels of provision.Conclusions: The framework provides a theoretical basis for preventing distress through Psychological Prehabilitation for Cancer Treatment. It can guide intervention design, staff training, and evaluation. Research priorities are to test its mechanisms, evaluate it as a complex intervention, and develop brief screening tools that predict future distress.
Language: English
Topic: Cancer survivorship and care
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7213888365