Smartphone app for monitoring after cancer surgery improves quality of recovery
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A smartphone app-assisted postoperative monitoring intervention improved quality of recovery after cancer surgery, according to results of a study conducted at University of Calgary.
The research team, led by Claire Temple-Oberle, MD, and Gregg Nelson, MD, PhD, assessed recovery quality and satisfaction among 72 patients randomly assigned to receive either conventional, in-person follow-up surveillance or smartphone app-facilitated follow-up after surgery. The intervention adhered to enhanced recovery after surgery (ERAS) protocols that Temple-Oberle and Nelson helped create for their respective disciplines, breast reconstruction surgery and gynecologic oncology surgery.
“As ERAS gets better and better, patients are going home sooner and may be at home for between 4 and 6 weeks before they have a true connection again with their surgical team,” Nelson, professor and deputy department head in the department of obstetrics and gynecology at University of Calgary, told Healio. “Patients have expressed to us that it would be great if they could somehow extend the excellent care beyond the walls of the hospital. So, we got the idea to create a more direct link with patients while they are recovering at home.”
Nelson spoke with Healio about the goals of the study, how the intervention performed and the long-term implications of these findings.
Healio: How did this study come about?
Nelson: In recent decades, we have made many advances in management of patients around the time of surgery, especially in terms of ERAS protocols. Much of that focus has been specifically on the days before surgery and during surgery, but also postoperatively. We’ve seen significant benefits in terms of reduction in length of stay and complications when we apply these protocols to patients.
A number of our patients told us how thrilled they were with the care they received leading up to the surgery and while in the hospital, and that they would like to have that level of care continue at home.
We had the idea to create a recovery app that builds upon principles of ERAS and keeps patients connected. This aligns with the priority to keep patients at home when they can be at home. We also want to take every opportunity to bring patients back into the health care system when they tell us about these legitimate concerns. As we know, many patients travel great distances for many hours to come back to see their surgeon or specialist.
Healio: How did you conduct this study?
Nelson: We randomly assigned patients who had undergone breast reconstruction surgery or major gynecologic oncology surgery in a one-to-one fashion to receive follow-up that was assisted by the smartphone app vs. conventional in-person follow-up. For breast reconstruction surgery, standard follow-up is typically more frequent than for gynecologic oncology follow-up. Usually, patients are seen every couple of weeks after breast reconstruction surgery, whereas in gynecologic oncology, they are usually seen at 4 weeks and in some cases at 6 weeks.
We then asked patients assigned to the app group and the conventional follow-up to fill out questionnaires. Most notable among these was the Quality of Recovery-15 (QoR-15) scale, a validated questionnaire that asks patients about 15 dimensions of health — how they are feeling in terms of pain, emotional state and more. We also had both groups fill out the patient satisfaction questionnaire-III (PSQ-III). We looked at additional factors such as complications and return to the ED.
Healio: What did you find?
Nelson: The main study finding, which we were very excited about, was that the app group had significantly higher QoR-15 scores compared with the control group — and not just at 2 weeks, but also at 6 weeks after surgery.
I would note that there has been a bit of a shift in terms of the surgical outcome literature, specifically in relation to patient-reported outcomes. Historically, in surgical studies, we would be more focused on things like hospital length of stay and complications. These are very important, but it’s also important to know how the patient is actually experiencing things. That is why we chose this particular validated metric, the QoR-15 score, which was able to capture how patients felt they were doing. We found that patients in both groups had equivalent satisfaction. Also, in terms of the time and expense of patients having to drive to the hospital, we found that the indirect costs were lower in the app group compared with the group that did not have the app. That was another important finding.
Healio: What do you expect to be the long-term implications of this study?
Nelson: Dr. Temple-Oberle and I hope that when health care systems such as ours or elsewhere throughout North America look at these types of findings, they will start to turn the dial on having technology — specifically smartphone technology — become something that is a bit more readily adopted in patient care. Smartphones are the one thing that the majority of our patients across different societies have. It seems like people rely on these for many things we do on a day-to-day basis, so it seems strange that we’re not using them to their full potential.
We hope health care systems will start to take this a bit more seriously and view it as something that could be scaled up and spread across different jurisdictions. I don’t think it is necessarily just for surgery. Patients who come in for a major medical illness and are told to follow up with their team 6 to 8 weeks down the road could also use this as a way to stay connected with their medical team.
Healio: Is there anything else you would like to say about your findings?
Nelson: Some may be skeptical of this approach, especially as it relates to the concepts of physician or health care provider burnout. Some may worry that rather than seeing patients, specifically within a defined clinic setting, they may suddenly have members of the health care team wanting to get in touch outside of clinic times. In this study, Dr. Temple-Oberle and I specifically managed time where we would be looking at the portal to review patient concerns. However, you could imagine a situation where it keeps adding to your clinical workload. So, there would have to be mechanisms put in place, perhaps by the health care system, to ensure we’re not just trading one problem for another as far as clinical volume.
For more information:
Gregg Nelson, MD, PhD, can be reached at Cumming School of Medicine, University of Calgary, 1331 29 St. NW, Calgary, Alberta, Canada T2N 4N2; email: gregg.nelson@ahs.ca; Twitter @GreggNelsonERAS.
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