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

项目摘要 肺癌是美国癌症相关死亡的主要原因。高达30%的患者可能是 有资格接受手术切除治疗。然而，目前，超过一半的接受肺部手术的患者 癌症切除是老年人(≥65岁)，70%的胸部手术患者是“体弱前期”或 “虚弱。”虚弱预示着不良的围手术期结果，如术后并发症增加， 住院时间、住院费用、出院后住院和死亡率。美国理工学院 外科医生和其他国际社会建议通过为患者提供康复治疗来缓解虚弱。 (Prehab)侧重于锻炼、营养和社会支持的计划。然而，尽管有证据表明， 临床试验，只有10%-30%的患者实际上坚持康复前计划和这些计划的翻译 项目进入临床实践一直是具有挑战性的。在我们对BeFitMe™的初步研究中，这是一款前置智能手机 提供、鼓励和跟踪家庭自我指导练习的应用程序，基于National 老年研究所Go4Life的锻炼视频中，只有14%的患者下载了这款应用。然而，那些这样做的人 下载这款APP的平均每天锻炼时间为38±8.8分钟，每天步行1862±2000步，平均11.9±4.3步 前驱活动天数；非吸毒者更有可能是年龄较大的男性和黑人。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和 坚持不懈。事实上，我们不知道目前有任何预修项目应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、价值和偏好的方法； 尤其是老年人。此外，没有项目报告使用执行科学原理来引入 并使干预措施适应不同的临床情况。作为第一阶段的NIH行为阶段模型研究 干预发展，我们建议(1)收集最终用户(患者、护理人员、临床医生)的观点 并聘请他们作为联合设计师重新设计和增强BeFitme™，以增加其使用率和参与度 在接受肺癌手术的老年人中，以及(2)使用执行框架来增加 预培训计划的覆盖面、采用率和可持续性。为了实现我的直接目标，即加强 现有的预康复应用程序，以优化其使用的先天/虚弱的老年肺癌患者谁将接受 我召集了一支以用户为中心的设计、实施科学、定性的专家团队 研究、预科、老年肿瘤学、肺癌和胸外科。我的长期目标是成为一名 独立调查人员专注于优化医院前、医院内和医院后阶段的 老年肺癌患者的外科治疗。

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.