Designing for Impact: Multidisciplinary Program to Identify Novel Interventions in Support of Recovery After Major Cancer Surgery

Authors

Carmit McMullen, Kaiser Permanente Center for Health Research, Portland, ORFollow
Matthew Nielsen, University of North Carolina School of Medicine, Chapel Hill, NC
Alison Firemark, Kaiser Permanente Center for Health Research, Portland, OR
Denise Nakatani, Kaiser Permanente Northern California, Oakland, CA
Jean Tuthill, Kaiser Permanente Northern California, Oakland, CA
Ruth McMyn, Kaiser Permanente Northern California, Oakland, CA
Anobel Odisho, Department of Urology, University of Washington, Seattle, WA
Michael Meyers, University of North Carolina School of Medicine, Chapel Hill, NC
David Shibata, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
Scott Gilbert, Moffitt Cancer Center, Tampa, FL

Publication Date

8-10-2017

Keywords

cancer, ethnography, acute inpatient care, communication, patients, providers, engagement of stakeholders

Abstract

Background: Cancer surgery is complex and is associated with significant patient morbidity, yet few resources exist to prepare patients for the complications and challenges that may follow surgery. Bladder and colorectal cancer patients who receive urinary or intestinal diversions face numerous issues that predispose them to high rates of distress and complication.

Methods: After preliminary ethnographic research to identify design challenges, we held a user-centered design (UCD) workshop as a step toward developing patient- and caregiver-centered interventions to support preparation for and recovery after complex cancer surgery. We used standard UCD methods and guiding principles during the workshop, focusing on innovative and broad-scope thinking. The workshop, held in late 2014, was attended by 3 colorectal/oncologic surgeons, 3 urologic surgeons, 5 ostomy nurses, 4 patients and caregivers, and 3 experienced UCD facilitators. Concepts that emerged from brainstorming sessions were visually represented on storyboards and voted on by the group. Highly scored concepts were further developed in small-group prototyping sessions and then presented to the entire group for review. All materials created were collected, discussions were recorded, and data were later analyzed to identify opportunities for intervention.

Results: Analysis revealed that needed educational information and resources about the surgery and recovery are generally inadequate, and that design solutions should focus on the goal of enhancing appropriate self-care during the recovery period. Four opportunity areas toward this goal were identified: 1) developing multimedia patient-education material available prior to surgery; 2) developing personalized discharge assessment and care plans; 3) creating a follow-up care tool that combines educational resources, self-management assistance and symptom monitoring capabilities; and 4) developing telehealth platforms to aid patients who cannot return to formal care settings easily.

Conclusion: Diverse stakeholders concluded that research and practice improvement should prioritize the development of education and communication pathways before surgery and postoperative communication interventions, all aimed at improving appropriate self-care during recovery.

Recommended Citation

McMullen C, Nielsen M, Firemark A, Nakatani D, Tuthill J, McMyn R, Odisho A, Meyers M, Shibata D, Gilbert S. Designing for impact: multidisciplinary program to identify novel interventions in support of recovery after major cancer surgery. J Patient Cent Res Rev. 2017;4:186.