Understanding support needs for family-participatory prehabilitation before hepatectomy: a qualitative study on Chinese patients and family caregivers.
You C, Li H, Shari N, Li J • Frontiers in public health • 2026
Family involvement in prehabilitation before hepatectomy should not be reduced to asking relatives to monitor patients, but requires professional guidance, negotiated patient-caregiver roles, protection of patient autonomy, assessment of caregiver capacity, low-literacy delivery, and attention to cost.
Key Findings
Results
Professional authority was a key factor that helped patient-caregiver dyads accept prehabilitation before hepatectomy.
Six themes emerged from interviews with 11 patient-caregiver dyads
Professional endorsement was identified as a facilitator of program uptake
Participants expressed that guidance from clinical professionals lent legitimacy to prehabilitation activities
This theme was identified through qualitative descriptive dyadic interviews at a tertiary hospital in Sichuan Province, China
Results
Disease status, finances, work obligations, and family roles collectively shaped preoperative uncertainty for patients and caregivers.
These factors were identified as a distinct theme from analysis of 11 patient-caregiver dyad interviews
Participants ranged in age from 43 to 73 years (mean 57.4 years)
Most caregivers were patients' spouses (n = 8), meaning financial and family role pressures often fell on the same individual
Preoperative uncertainty was framed as a barrier to prehabilitation engagement
Results
Families functioned as the primary implementation unit for prehabilitation, rather than patients acting independently.
This was identified as one of six emergent themes across all 11 dyads
Prehabilitation occurs mainly at home, making family caregiver involvement structurally central
The finding underscores that the unit of intervention should be the dyad rather than the individual patient
This theme was developed through independent coding by two researchers followed by team discussion
Results
Feasibility of prehabilitation was limited by patients' symptoms, knowledge gaps, family relationship dynamics, and available resources.
These barriers were identified as a distinct theme across the 11 patient-caregiver dyads
Knowledge gaps and low health literacy were specifically noted as constraints
Resource limitations included financial and material constraints
Family relationship dynamics could either support or hinder program adherence
Results
Family support was not always facilitative, as patients sometimes felt their autonomy was reduced by caregiver involvement.
Reduced patient autonomy was identified as a distinct barrier within family support interactions
Patients and caregivers often described burden and acceptable supervision differently
This tension suggests that caregiver monitoring without negotiated roles can be counterproductive
The finding indicates that family involvement must protect patient autonomy to be effective
Results
Participants preferred prehabilitation support that was specific, personalized, low-burden, and sustainable.
These preferences were identified as a unified theme across patient and caregiver responses
Low-literacy delivery was specifically highlighted as a preference, indicating written or complex materials may be inadequate
Attention to cost was noted as a participant-identified requirement for sustainability
Preferences for personalization suggest that standardized, one-size-fits-all programs may be insufficient
Conclusions
A workable family-participatory prehabilitation model requires professional guidance, negotiated patient-caregiver roles, protection of patient autonomy, assessment of caregiver capacity, low-literacy delivery, and attention to cost.
These components were derived from synthesis of all six themes across 11 dyadic interviews
The study used purposive maximum variation sampling to maximize diversity of perspectives
Interviews were conducted separately with patients and caregivers to capture divergent viewpoints
Participants were recruited from February to June 2026 at a tertiary hospital in Sichuan Province, China
What This Means
This research suggests that preparing patients for liver surgery (hepatectomy) through exercise and other health behaviors before the operation—a process called prehabilitation—is significantly shaped by the involvement of family members. The study interviewed 11 pairs of patients and their family caregivers in China and found that while families are central to helping patients follow through with prehabilitation at home, simply asking relatives to supervise or remind patients is not enough and can even backfire. Patients sometimes felt their independence was undermined when caregivers monitored them too closely, and patients and caregivers often had different ideas about what felt like helpful support versus unwanted pressure.
The study identified six key themes: trust in medical professionals helped families accept prehabilitation; uncertainty caused by illness, finances, and family responsibilities made preparation harder; families naturally became the main team carrying out prehabilitation; practical barriers like symptoms, lack of knowledge, and limited resources reduced feasibility; overly controlling caregiver support could reduce patient motivation; and both patients and caregivers wanted guidance that was tailored, simple, affordable, and realistic to maintain. These findings highlight that effective family involvement requires clear professional guidance, agreed-upon roles between patients and caregivers, and careful attention to each family's unique circumstances and resources.
This research suggests that future prehabilitation programs designed for patients awaiting liver surgery should treat the patient and caregiver as a unit rather than focusing on the patient alone. Programs should include strategies to protect patients' sense of control, assess whether caregivers themselves have the capacity to help, provide information in easy-to-understand formats, and account for the financial costs families may face. These insights are particularly relevant for healthcare settings in China and similar contexts where family caregiving is culturally central but formal support structures may be limited.
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You C, Li H, Shari N, Li J. (2026). Understanding support needs for family-participatory prehabilitation before hepatectomy: a qualitative study on Chinese patients and family caregivers.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1916113