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 适合手术切除治疗。然而，目前，超过一半的肺移植患者 癌症切除术的患者为老年人（≥ 65岁），70%的胸外科患者为"虚弱前期"或 "脆弱"虚弱预示着不良的围手术期结局，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。the American College of 外科医生和其他国际协会建议通过为患者提供预防措施来缓解虚弱 （prehab）计划，重点是锻炼，营养和社会支持。然而，尽管有证据表明， 在临床试验中，只有10 - 30%的患者实际上坚持prehab计划和翻译这些 临床实践中的实践是具有挑战性的。在我们对BeFitMe ™（一种prehab智能手机）的初步研究中， 应用程序，提供，鼓励和跟踪自我指导的家庭锻炼，根据国家 在老年研究所的Go4Life运动视频中，只有14%的患者下载了该应用程序。 下载应用程序平均每天锻炼38 ± 8.8分钟，每天1，862 ± 2000步，每天11.9 ± 4.3步。 天的prehab活动;非用户更有可能是老年人，男性和黑人。缺乏强有力的"最终用户" 对干预措施设计，特别是行为干预措施的投入，可能导致可接受性差， 坚持。事实上，我们不知道任何当前的prehab程序，适用于以用户为中心的设计 充分确定和解决最终用户的具体需要、价值观和偏好的方法， 尤其是老年人。此外，没有项目报告使用实施科学原则来引入 并使干预适应不同的临床环境。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，临床医生）的观点 并让他们作为共同设计师参与重新设计和增强BeFitMe ™，以增加其使用和参与 在接受肺癌手术的老年人中，（2）使用实施框架， prehab项目的覆盖面、采用率和可持续性。为了实现我的近期目标， 现有的prehab应用程序，以优化其使用前/体弱老年人肺癌患者谁将接受 切除，我召集了一个专家团队，在以用户为中心的设计，实施科学，定性 研究、康复、老年肿瘤、肺癌和胸外科。我的长期目标是成为一名 独立调查员专注于优化院前，院内和院后阶段， 虚弱前/虚弱老年肺癌患者外科护理。

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.