JMIR Publications

ABSTRACT

Background:

Older adults (age 65 years and over) account for approximately 30% of inpatient procedures performed in the US. After major surgery, older adults are at high risk of a slow return to previous functional status, loss of independence, and complications, such as delirium. With the development and refinement of Enhanced Recovery After Surgery (ERAS) protocols, older patients often return home much earlier than historically anticipated. This puts a larger burden on care-partners, close family or friends who partner with the patient and help guide them through recovery. If these patients and their care-partners are not fully prepared for the operation and recovery, poor long-term outcomes may result.

Objective:

The goal of this study is to improve and streamline recovery for patients 65 years and older by exploring the communication needs of patients and their care-partners. Information from this study will be used to inform an intervention developed to address these needs as well as define processes to implement this intervention across surgical clinics.

Methods:

This study has two aims. First, we will define patient and care-partner needs and perspectives related to a digital health innovation. To achieve this aim, we will recruit dyads of patients (ages 65+) who underwent elective major surgery 30-90 days prior and their respective care-partners (ages 18+). Participants will undergo individual qualitative interviews and complete individual surveys to obtain demographic data, characterize their perceptions of the surgical experience, identify intervention targets, and assess for the type of intervention modality that would be most useful. Next, we will explore clinician perspectives, tools and strategies to develop a blueprint for a digital intervention. To achieve this aim, we will recruit clinicians (e.g. geriatricians, surgeons, and nurses) who will participate in focus groups that will assess current obstacles affecting surgical outcomes among older patients, and review current assessments and tools used in their clinical practice. We will use these clinician and patient perspectives to inform the development of a digital intervention strategy to support older patients and their care-partners after surgery.

Results:

This study has been approved by the Massachusetts General Hospital and Harvard Institutional Review Boards. Study completion anticipated by Fall 2024.

Conclusions:

Information from this study will be leveraged to develop a scalable digital health option for older patients undergoing major surgery and their care-partners. Through this work we will improve our understanding of patient recovery needs and how to improve communication with surgical teams. The ultimate goal of this work is to decrease the overall burden on patients, their care-partners, and healthcare providers to achieve shared understanding while meeting personal recovery needs through real-time assessment.