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 肺癌是美国与癌症有关的主要原因。多达30％的患者可能是 兼容手术切除以进行治疗。但是，目前，超过一半的患者接受肺 癌症切除是老年人（≥65岁），有70％ “脆弱。”脆弱预示了较差的时期结果，例如术后并发症增加， 住院时间，医院费用，入院后的制度化和死亡率。美国学院 外科医生和其他国际社会建议通过为患者提供预居住 （前）专注于运动，营养和社会支持的计划。然而，dospite的效率证据 临床试验，只有10-30％的患者实际上遵守了预性行为计划，而这些患者的翻译 临床实践的计划受到挑战。在我们的Prehab智能手机Befitme™的试点研究中 根据民族，提供，鼓励和跟踪自我引入的家庭练习的应用 老化Go4Life练习视频研究所，只有14％的患者下载了该应用程序。但是，那些这样做的人 下载该应用程序平均每日练习38±8.8分钟，每天1,862±2000步，11.9±4.3 预险活动的日子；非用户更有可能年龄较大，男性和黑色。缺乏强大的“最终用户” 对干预设计的输入，尤其是行为干预措施，可能导致可接受性差，并且 坚持。确实，我们不知道任何应用以用户为中心的设计 充分确定和满足最终用户的特定需求，价值和偏好的方法， 特别是老年人。此外，没有使用实施科学原则介绍的计划报告 并将干预措施适应各种临床环境。作为阶段，我在行为的NIH阶段模型中研究 干预开发，我们建议（1）收集最终用户（患者，看护人，临床医生）观点 并将它们作为共同设计者进行重新设计并增强Befitme™以增加其使用和参与 在接受肺癌手术的老年人中，（2）使用实施框架来增加 预先爆炸计划的覆盖，采用和可持续性。为了实现我的直接目标 现有的prehab应用程序，以优化预防/脆弱的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，preab，老年肿瘤学，肺癌和胸外科手术。我的长期目标是成为一个 独立研究人员致力于优化院前，院内和医院后阶段 前养/虚弱的老年人肺癌的手术护理。

项目成果

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

• DOI: 10.1186/s12877-024-04743-6
• 发表时间: 2024-02-02
• 期刊: BMC GERIATRICS
• 影响因子: 4.1
• 作者: Kerstiens, Savanna;Gleason, Lauren J.;Huisingh-Scheetz, Megan;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.