JMIR Publications

ABSTRACT

Background:

Effective postoperative pain management is critical to surgical recovery; however, patients frequently report feeling inadequately prepared before and after surgery, resulting in uncertainty regarding pain expectations and medication use. We developed the Managing Pain After Laparoscopic Surgery (M-PALS) website as an evidence-based digital resource to provide tailored information on pain expectations, medication options, and safe medication practices for patients, caregivers, and care team members. Evaluating digital health resources before routine integration into clinical practice is essential for identifying barriers, ensuring usability, and refining implementation strategies.

Objective:

This protocol outlines an iterative, formative pre-implementation evaluation designed to (1) assess website usability, acceptability, appropriateness, and feasibility among patient, caregiver, and care team member end users; (2) identify perceived facilitators and barriers to clinical workflow integration among care team members; (3) evaluate patient behavioral implications (e.g., pain expectations, medication decision-making, and patient-provider communication); and (4) guide multi-stage website refinements, both mid-evaluation and post-analysis, in advance of systemwide clinical implementation.

Methods:

We are conducting an iterative mixed-methods quality improvement evaluation that combines semi-structured interviews and validated survey scales with laparoscopic surgery patients and members of the multidisciplinary care team at a large academic health system. We interviewed an initial cohort of patients to evaluate the website’s usability, acceptability, appropriateness, and feasibility to guide initial website refinements. Following these updates, we continue to interview a follow-up cohort of patients to assess perceived behavioral impacts, including pain expectations, medication decision-making, and patient-provider communication. Concurrently, we are interviewing care team members to evaluate the website’s usability, acceptability, appropriateness, and feasibility, as well as its integration into clinical workflows prior to broader clinical implementation. We will measure quantitative outcomes using the System Usability Scale, Acceptability of Intervention Measure, Intervention Appropriateness Measure, and the Technology Acceptance Model-Perceived Ease of Use subscale. We will analyze quantitative data using descriptive statistics and qualitative data using a human-in-the-loop, generative artificial intelligence-assisted thematic analysis framework.

Results:

A total of 24 postoperative patients (n=13 pre-website refinement; n=11 post-website refinement) and 5 care team members completed evaluation activities. The first patient cohort feedback directly informed iterative website updates. All cohorts will inform website updates prior to broader implementation. Analyses are ongoing and expected to conclude by December 2026.

Conclusions:

Conclusions:

This evaluation provides actionable insights into user experience and clinical feasibility, guiding final refinements of the M-PALS website prior to broader implementation at the participating healthcare system. This evaluation offers a replicable model for pre-implementation evaluation of digital patient education tools in surgical care settings.