Prehabilitation Closer to Home Study: Novel Evaluation of a Co-designed Pre-habilitation Exercise service for Haematological Cancer Patients Preparing for Bone Marrow Transplantation.

Standard care: All bone marrow transplant patients at Peter Mac are offered a face-to-face exercise assessment, and then some level of support for exercise depending on their risk level. Medium and High-risk patients are offered supervised sessions; Three days a week face-to-face, two days via tele-health. Patients are encourage to attend 2-3 sessions per week. All patients are offered an individualised home-based exercise program based on the in-person assessment. The program generally includes a prescription of aerobic and resistance-based activity, with a focus on working towards exercise and cancer guidelines (see ACSM Exercise Guidelines for Cancer Survivors e.g., activities include moderate intensity walking and strength exercises using major muscle groups, such as a sit-to-stand). The home-based program is delivered via simple set, which is a software package health care professionals can you to prescribe and exercise program that is printed out as an exercise diary for patients to take home and complete. The frequency of follow-up depends on the risk category (weekly, fortnightly, monthly for high, medium and low risk, respectively). Co-designed components to be integrated into standard care. Additions to standard care were developed as part of a co-design process. Co-designed components include: Package 1: • New training module for staff on delivering exercise services using a trauma-informed approach. This is a 20 minute online module that explains the concept and prevalence of trauma, explores the ket elements of trauma informed care, and provides scenario-based learning opportunities, including two videos to watch and multiple choice questions. All staff involved in delivering the exercise service will be directed to complete this module within two weeks of trial commencement by the clinical lead of the service. • New training module for staff on delivering engaging online exercise classes This is a 15 minute online module developed based on Social Identity Leadership Theory and consumer suggestions for how to improve online exercise classes. It covers patient concerns about online exercise classes (from our survey research and other published research), effective leadership styles, and consumer-suggested strategies that map to successful leadership approaches. All staff involved in delivering the exercise service will be directed to complete this module within two weeks of trial commencement by the clinical lead of the service. • Update to staff operating procedure documents (Prehabilitation Manual and Online Exercise Class Manual) to reflect key points in training modules and direct staff to online training modules - to be implemented at least two weeks prior to trial commencement. • New patient-facing printed materials (designed specifically for this study) providing educational content and behaviour change support (e.g., tips for overcoming barriers, education on exercise benefits). Package 2: * Same components as above, as well as a: •. New Patient-facing website (designed specifically for this study) providing educational content and behaviour change support. Participants will be informed of the website during their initial appointment and provided with a document containing the URL and a QR code. There is no set intended usage for the website. Participants can look at it as needed. (Mirrors printed booklet with increased interactivity, and multi-media). Iterative optimisation protocol: Package 1 will be implemented first, and continue until either 60 people are recruited or the trial is stopped early due to too few promising responses (determined in an interim analysis at 30 people). The package 1 trial period is estimated to be 6 months. After package 1 has been trialed, the co-design team will optimise Package 2 by making intervention or implementation refinements where possible (if necessary) based on all available data (as per Ethics approval HREC/81951/PMCC). Package 2 will then be implemented to a new cohort of participants, with the same evaluation protocol as the Package 1 trial. The package 2 trial period is estimated to be 6 months. Adherence Training Modules: A link to the training modules is included in the standard of care manual. The lead physiotherapist will also encourage staff to complete the training. Staff use of modules, as well as generally acceptability will be obtained via staff interview at the end of the trial period. Printed booklets (patient) participants will be asked via survey at follow-up if they were given the printed booklet and if they read it. Website (patient): participants will be asked via survey at follow-up if they were given information about the website and if they used it. The number of users of the website and what pages are visited will also be tracked.