Prioritising Psychological Prehabilitation Interventions for Cancer Surgery: An International Delphi Study

Background: Preoperative mental wellbeing is an important determinant of postoperative recovery, yet psychological care is frequently overlooked within multidisciplinary prehabilitation programmes. When included, psychological interventions are fragmented and inconsistently delivered. This study aimed to establish international multidisciplinary consensus on preferred psychological prehabilitation interventions for patients undergoing urogenital, thoracic or gastrointestinal cancer surgery, and to describe current practice. Methods: A three-round Delphi was conducted between February and September 2025. An international multidisciplinary expert panel rated the perceived effectiveness of each intervention for urogenital, thoracic and gastrointestinal cancer surgery using a 5-point Likert scale. Predefined criteria classified interventions as effective, ineffective, contested or indeterminate. Round 1 also captured current models of psychological prehabilitation delivery. Results: In total, 439 participants completed Round 1, with 191 and 234 completing Rounds 2 and 3, respectively. Nine interventions reached consensus as endorsed across all tumour types, with supportive counselling, personalised coping strategies, cognitive behavioural therapy and mindfulness-based techniques reaching the strongest agreement. Sexual health counselling was endorsed only for urogenital cancers. No interventions reached consensus as ineffective; however, hypnotherapy and eye movement desensitisation and reprocessing were contested in specific cancer groups, whilst metacognitive therapy remained indeterminate. International practice was heterogeneous, with limited routine screening, variable access to psychological services and funding/resource constraints as common barriers. Conclusion: This international Delphi study identified a core set of consensus-based psychological prehabilitation interventions for cancer surgery, providing a foundation for clinical implementation. Future research should prioritise hybrid effectiveness-implementation designs, generating data on optimal providers, delivery formats and patient characteristics.