Preoperative cognitive restructuring improves psychological distress and subjective well-being of high-risk patients scheduled for major surgery in a context of multimodal prehabilitation program

Background and aims Multimodal Prehabilitation (M-PreHab) consists of preoperative medical, functional, nutritional, and psychological interventions to facilitate surgical recovery. Cognitive restructuring (CR) is a well-known psychotherapeutic ingredient of cognitive-behavioural psychotherapy aiming at treating psychological distress. It might be a valuable intervention to propose in this clinical context. Method High-risk patients scheduled for major surgery were referred to the Careggi Prehabilitation Center (Florence, Italy) and evaluated at baseline (T0) and after M-PreHab (T1). Their functional status was assessed with the 6-Minute Walking Test (6MWT); nutritional status with the Patient-Generated Subjective Global Assessment (PG-SGA); psychological distress with the Hospital Anxiety and Depression Scale (HADS); psychological distress with the Symptom Checklist-90-Revised; well-being with the World Health Organization Five Well-Being Index (WHO-5). Patients received a personalized M-PreHab based on their clinical needs. Patients with psychological distress were treated with CR therapy. A preoperative functional change (6-minute walking distance change ≥19m between T0 and T1) was used to determine a clinically meaningful response to the M-PreHab treatment. Results 186 patients treated with M-PreHabM underwent surgery. At T0, n = 80 (43%) patients were found to require psychological support (HADS-Anxiety and/or HADS-Depression ≥ 7): of these, only n = 22 (27.5%) agreed to begin CR therapy; n = 16 (20%) completed the psychological program (weekly CR therapy sessions) in the preoperative period, showing an improvement in anxiety, depression, psychological distress, psychological well-being; an improvement of functional and nutritional status was also observed. Patients who benefited from M-PreHab showed lower functional levels, worse nutritional status, higher levels of psychological distress, and reduced well-being at T0 compared to patients who did not benefit from it. Patients who benefited from M-PreHab showed functional, nutritional, and psychological improvement at T1; patients who did not benefit from M-PreHab slightly worsened their functional status, maintained a poor nutritional status, but still improved their psychological distress. Patients who refused CR therapy marginally improved the functional, nutritional and psychological status. Discussion These preliminary data showed that in the context of M-PreHab, the majority of patients with psychological distress refuse to be supported. Among those receiving CR therapy psychological improvement is independent from functional and nutritional improvements; patients who functionally and nutritionally deteriorated still showed less psychological distress and improved their psychological well-being after CR therapy. Conclusion CR technique might represent a promising psychological intervention in the context of a MP program, to support high-risk patients scheduled for major surgery, even when disease progresses.