Applying User-centered Design and Implementation Science to Enhance Prehabilitation for Frail Older Adults Undergoing Lung Cancer Surgery

应用以用户为中心的设计和实施科学来加强接受肺癌手术的体弱老年人的康复

• 批准号: 10727197
• 负责人: Maria Lucia Madariaga
• 金额: $ 16.4万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10727197
• 关键词: Address; Adherence; Adoption; Aging; American College of Surgeons; Behavior Therapy; Behavioral Model; Behavioral trial; Black race; Cancer Etiology; Cancer Patient; Caregivers; Caring; Cessation of life; Clinic; Clinical; Clinical Trials; Devices; Effectiveness; Elderly; Eligibility Determination; Evaluation; Evidence based intervention; Evidence based practice; Excision; Exercise; Failure; Feedback; Focus Groups; Foundations; Frail Elderly; Future; Goals; Habilitation; Health; Health Care Costs; Heterogeneity; Home; Hospital Costs; Hospitals; Institutionalization; International; Intervention; Interview; Knowledge; Length of Stay; Malignant neoplasm of lung; Medical; Modification; Motivation; National Institute on Aging; Oncology; Operative Surgical Procedures; Outcome; Patients; Perioperative; Phase; Physiological; Pilot Projects; Postoperative Complications; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Records; Reporting; Research; Research Personnel; Scientist; Social support; Societies; Structure; Text Messaging; Thoracic Surgical Procedures; Time; Translating; Translations; United States; United States National Institutes of Health; behavior change; cancer surgery; clinical practice; design; evidence base; experience; forgetting; frailty; implementation framework; implementation science; improved; innovation; male; mortality; nutrition; older patient; patient engagement; physical conditioning; preference; programs; risk mitigation; screening; smartphone application; surgery outcome; therapy design; therapy development; treatment effect; uptake; user centered design

Project Abstract Lung cancer is the leading cause of cancer-related death in the United States. Up to 30% of patients may be eligible for surgical resection for treatment. Currently, however, more than half of patients undergoing lung cancer resection are older adults (≥65 years) and 70% of thoracic surgery patients are “pre-frail” or “frail.” Frailty portends poor perioperative outcomes, such as increased postoperative complications, length of stay, hospital costs, post-discharge institutionalization and mortality. The American College of Surgeons and other international societies recommend frailty mitigation by offering patients prehabilitation (prehab) programs that focus on exercise, nutrition, and social support. Yet, despite evidence of efficacy in clinical trials, only 10-30% of patients actually adhere to prehab programs and the translation of these programs into clinical practice has been challenging. In our pilot study of BeFitMe™, a prehab smartphone application that provides, encourages, and tracks self-guided at-home exercise, based on the National Institute of Aging Go4Life exercise videos, only 14% of patients downloaded the app. However, those who did download the app averaged 38 ± 8.8 minutes of daily exercise, 1,862 ± 2000 steps per day, and 11.9 ±4.3 days of prehab activity; non-users were more likely to be older, male, and Black. Lack of robust “end-user” input into intervention design, particularly behavioral interventions, can lead to poor acceptability and adherence. Indeed, we are unaware of any current prehab program that applied a user-centered design approach to fully ascertain and address the specific needs, values, and preferences of the end-users, particularly older adults. Furthermore, no programs report using implementation science principles to introduce and adapt the intervention to varied clinical contexts. As a Stage I study in the NIH Stage Model for Behavioral Intervention Development, we propose to (1) Gather end-user (patients, caregivers, clinicians) perspectives and engage them as co-designers to redesign and enhance BeFitMe™ to increase its use and participation among older adults undergoing lung cancer surgery and (2) Use an implementation framework to increase reach, adoption, and sustainability of the prehab program. To achieve my immediate goal of enhancing the existing prehab app to optimize its use by prefrail/frail older adult lung cancer patients who will undergo resection, I have convened a team of experts in user-centered design, implementation science, qualitative research, prehab, geriatric oncology, lung cancer, and thoracic surgery. My long-term goal is to become an independent investigator focused on optimizing the pre-hospital, in-hospital, and post-hospital phases of surgical care for prefrail/frail older adults with lung cancer.

项目摘要 肺癌是美国癌症相关死亡的主要原因，高达 30% 的患者可能患有肺癌。 然而，目前有超过一半的患者接受肺部手术切除。 癌症切除手术对象是老年人（≥65岁），70%的胸外科患者处于“体弱前”或 “虚弱”预示着围手术期结果不佳，例如术后并发症增加， 住院时间、住院费用、出院后住院治疗和死亡率。 外科医生和其他国际协会建议通过为患者提供预康复来缓解虚弱 然而，尽管有证据表明其有效，但重点关注运动、营养和社会支持的（康复前）计划。 临床试验中，只有 10-30% 的患者真正遵守康复计划以及这些计划的转化 在我们对 BeFitMe™（一款康复前智能手机）的试点研究中，项目进入临床实践一直具有挑战性。 根据国家标准，提供、鼓励和跟踪自我指导的家庭锻炼的应用程序 老龄化研究所的 Go4Life 锻炼视频显示，只有 14% 的患者下载了该应用程序，但那些下载了该应用程序的患者却发现了这一点。 下载该应用程序 平均每天锻炼 38 ± 8.8 分钟，每天 1,862 ± 2000 步，以及 11.9 ±4.3 康复前活动的天数；非用户更有可能是老年人、男性和黑人。缺乏强大的“最终用户”。 对干预设计的投入，特别是行为干预，可能会导致可接受性差和 事实上，我们不知道目前有任何康复计划采用了以用户为中心的设计。 充分确定和解决最终用户的具体需求、价值观和偏好的方法， 特别是老年人。此外，没有任何计划报告使用科学原理来介绍实施情况。 并根据不同的临床环境调整干预措施，作为 NIH 行为阶段模型的第一阶段研究。 干预开发，我们建议 (1) 收集最终用户（患者、护理人员、皇帝）的观点 并让他们作为联合设计师重新设计和增强 BeFitMe™，以增加其使用和参与 在接受肺癌手术的老年人中，以及 (2) 使用实施框架来增加 康复计划的覆盖范围、采用率和可持续性，以实现我加强康复计划的近期目标。 现有的 Prehab 应用程序可优化即将接受治疗的前体衰弱/体弱老年肺癌患者的使用 切除，我召集了一个以用户为中心的设计、实施科学、定性的专家团队 研究、康复治疗、老年肿瘤学、肺癌和胸外科我的长期目标是成为一名医生。 独立研究者专注于优化院前、院内和院后阶段 患有肺癌的体弱前/体弱老年人的手术护理。

项目成果

Barriers and facilitators to smartwatch-based prehabilitation participation among frail surgery patients: a qualitative study.

体弱手术患者参与基于智能手表的预康复的障碍和促进因素：一项定性研究。

• 发表时间: 2024-02-02
• 影响因子: 4.1
• 作者: Kerstiens, Savanna;Gleason, Lauren J;Huisingh;Landi, A Justine;Rubin, Daniel;Ferguson, Mark K;Quinn, Michael T;Holl, Jane L;Madariaga, Maria Lucia L
• 通讯作者: Madariaga, Maria Lucia L