Background: Research has demonstrated a strong association between frailty and adverse outcomes in acute clinical settings (1). In relation to colorectal cancer resection surgery, it has been associated with severe postoperative complications, prolonged hospital stay, higher readmission rates, and increased short- and long-term mortality (2-4). Comprehensive geriatric assessment and care (CGA), including a tailored care plan, interprofessional assessments and support, has shown benefits across various care settings for frail older adults (5, 6). However, its integration into routine care within a surgical context remains limited. In an ongoing randomised controlled multicenter study (7), the effects of a period of preoperative optimisation (up to 8 weeks) involving CGA in addition to routine care before colorectal cancer surgery will be evaluated. To facilitate implementation, exploring and understanding the participants' perceptions of participating in a preoperative CGA intervention is crucial. The aim of this study was to describe how frail older adults with colorectal cancer experience participation in a preoperative CGA and care intervention.

Methods: This qualitative, descriptive study was derived from a randomised, controlled, multi-center study. In total, 20 semi-structured interviews with frail older adults undergoing a CGA-intervention before colorectal cancer surgery were conducted. The data were analysed using inductive qualitative content analysis (8).

Results: The analysis showed that frail older adults with colorectal cancer experienced participation in preoperative CGA as being an integral part of an intervention. They adopted an opportunity mindset when deciding to participate and felt privileged to have been part of the intervention, which meant a chance to extend life. They experienced a collaborative engagement that entailed mutual involvement of the team, the patient, and their relatives to achieve shared goals. Participants felt that they were acknowledged, their relatives were included, and the team was well-informed. However, despite their best efforts, they found the process demanding due to transportation challenges and numerous tasks during the waiting period. Throughout the intervention, they observed the team working collaboratively and actively involving them in the optimisation process, which enhanced their readiness for surgery by the end of the period.

Conclusions: The findings indicated that frail older adults with colorectal cancer viewed the preoperative CGA- intervention as a meaningful opportunity for improvement and a chance to extend life. Their active involvement and the collaborative efforts of the care team during the intervention were crucial in enhancing their understanding, manageability, and readiness for surgery. They valued the opportunity to make active choices when appropriate and appreciated having the right to delegate decisions to healthcare professionals. From a patient perspective, team-based approaches in preoperative care, such as CGA, offer many benefits in terms of involvement and satisfaction. However, a thorough evaluation of its medical effects remains necessary.