Development of an Education, Communication, and Monitoring System (eCare) After Gastrointestinal Cancer Surgery

After gastrointestinal (GI) cancer surgery, more than 30% of patients experience a major complication (e.g., infection) with nearly half occurring in the 1st month post-discharge from the hospital. Yet, the model of post-discharge surgical care still only involves a single clinic visit several weeks post-discharge. Hence, during the intervening period, the responsibility for monitoring a patient’s recovery shifts from the hospital surgical team to the patient and their caregivers. Indeed, most surgical care teams still rely on a reactive “wait and see” approach wherein patients initiate contact with any concerning signs (e.g., fever, wound redness) or symptoms (e.g., nausea). However, patients are often unable to distinguish between signs/symptoms suggestive of a complication (e.g., wound redness) from normal recovery (e.g., wound bruising), suggesting that patients are inadequately prepared for post-discharge recovery self-monitoring. Moreover, subtle symptoms, such as fever, wound redness or nausea can, if unrecognized, rapidly evolve. Such gaps in knowledge and preparation for self-monitoring also contribute to unwarranted patient distress, unnecessary emergency department (ED) and clinic visits, and multiple calls/messages to the surgical team. No platform currently exists that proactively prepares patients for, and supports, surgical post-discharge recovery monitoring. This project seeks to develop a patient-centered Education, Communication And monitoRing systEm (eCARE) that is integrated within patients’ electronic health records (EHRs) to address all aspects of post-discharge monitoring. The long-term objective of this work is to improve the quality and safety of GI cancer surgery. The specific aims are to: (1) design and create eCARE, a novel, interactive platform, to support post-discharge GI cancer surgery patient education, communication, and monitoring and (2) iteratively revise and implement eCARE in three cancer surgery clinics eventually leading to the evaluation of eCARE to assess post-discharge outcomes. eCARE leverages technology to prepare patients for post-discharge recovery self-monitoring by delivering, beginning before surgery, essential education and information, proactively soliciting self-assessments of signs and symptoms, and facilitating interactive communication to assess and manage concerning signs and symptoms. eCARE will improve patients’ engagement and activation for post-discharge self-monitoring, facilitate early management, and lead to reduced post-surgical complications. As a Career Development Award, the long–term goals of the candidate are to gain the necessary skills, expertise, and experience in user-centered design and learning science, implementation science, and pragmatic clinical trial design. In addition to being an ideal experiential vehicle for the applicant’s career development plan, the research project will result in a robustly designed, developed, and implemented health information technology (HIT) platform, eCARE, in preparation for a multi-site pragmatic clinical trial to assess eCARE’s effectiveness to reduce post-discharge complications after GI cancer surgery.