A multidisciplinary virtual (p)rehabilitation model of care for colorectal cancer surgery

BACKGROUND: Colorectal cancer is a leading cause of cancer-related morbidity and mortality globally, with surgery the primary curative treatment. Despite advances in medical care, postoperative complications are common, resulting in prolonged hospital stays, delayed recovery, diminished quality of life, and increased healthcare costs. This study aimed to develop a standardised, evidence-based, multidisciplinary virtual model of care for (p)rehabilitation (i.e., preoperative and postoperative rehabilitation) in colorectal cancer surgery patients. METHODS: This study reports the development of a multidisciplinary virtual prehabilitation model of care for the PRIORITY-CONNECT 2 randomised controlled trial. A collaborative framework was developed between Royal Prince Alfred Hospital (Sydney) and Peter MacCallum Cancer Centre (Melbourne), two major Australian colorectal cancer treatment centres with extensive prehabilitation expertise. Five discipline-specific working groups were established to guide development of domains within the model of care, namely, nutrition counselling, peer support groups, psychology, physiotherapy and nursing. Each working group was comprised of discipline experts, colorectal surgeons, anaesthetists, and academic researchers, chaired by a senior discipline leader. Working groups convened virtually via Microsoft Teams between November 2024 and March 2025, meeting up to five times per discipline to achieve consensus on the final model of care. The approach integrated current literature, clinical expertise, and consumer perspectives to develop individualised care pathways spanning 1-6 weeks preoperatively through 12 months postoperatively. RESULTS: Five comprehensive discipline-specific virtual models of care were developed, delineating specific roles, interventions, timelines, and outcome measures aligned with the overall (p)rehabilitation framework. As a result, each specialty developed a comprehensive, evidence-based approach to manage patients with colorectal cancer undergoing surgery. The models of care are tailored based on initial preoperative assessment made by specialists and involve different pathways of care depending on patient needs. After surgery, all patients are reassessed by specialists and further management is tailored based upon the judgement of the clinician, patient preferences, and reported symptoms. CONCLUSION: This multidisciplinary, evidence-based model of care provides comprehensive guidance for implementing virtual (p)rehabilitation in people undergoing colorectal cancer surgery. By standardising care pathways across five key disciplines, while maintaining individualised approaches, this framework addresses critical gaps in clinical practice and provides a foundation for implementation and evaluation of (p)rehabilitation programs.