EP121 - Characteristics Associated with Pre-operative Engagement with a Web-Based Intervention Among Patients Undergoing Rectal Cancer Surgery

ePoster Presenter(s)

• 

  Ezra S. Brooks, MD

  Surgery Resident
  Brigham and Women's Hospital
  Brigham and Women’s Hospital
  Brookline, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Stefanie J. Soelling, MD, MPH

  Resident
  Brigham and Women's Hospital
  Boston, MA, United States

  Disclosure information not submitted.
• 

  Liliana Bordeianou, MD, MPHFASCRS

  Professor of Surgery
  Harvard Medical School; Mass General Brigham Division Colon and Rectal Surgery
  Harvard
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• SC

  Sevdenur Cizginer, MD, MPH

  Assistant Professor of Medicine
  Harvard Medical School, Mass General Hospital
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• MB

  Mary E. Brindle, MD MPH

  Director Safe Surgery Safe Systems
  Ariadne Labs, Harvard School of Public Health
  Calgary, Alberta, Canada

  Disclosure information not submitted.
• CR

  Christine Ritchie, MD, MSPH

  Professor of Medicine
  Massachusetts General Hospital and Harvard Medical School
  Charlestown, Massachusetts, United States

  Disclosure information not submitted.
• HK

  Hiroko Kunitake, MD MPH

  Associate Professor
  Harvard Medical School, Massachusetts General Hospital
  Harvard Medical School, Massachusetts General Hospital
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Rocco R. Ricciardi, MD

  Chief, Division of Colon & Rectal Surgery
  Massachusetts General Hospital
  Harvard University
  Boston, MA, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Christy Cauley, MD, MPH (she/her/hers)

  Associate Professor
  Mass General Brigham
  Massachusetts General Brigham; Harvard Medical School
  Winchester, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: Optimizing recovery after major rectal cancer surgery requires tailored support in the outpatient setting. Web-based interventions can be a helpful tool for improving patient-centered care by enabling dissemination of perioperative information, evaluation of patient baseline characteristics (e.g. smoking status and physical function), and remote support for recovery with daily health checks. Yet, not all patients are willing to engage with these interventions. In this study, we aimed to evaluate preoperative engagement rates with a web-based application and to assess characteristics associated with higher engagement among rectal cancer surgery patients.

Methods/Interventions: We included all adults 18 years or older undergoing elective rectal cancer resection at a large academic medical center (2020-2022). Patients with a confirmed surgical date were provided the option to sign up for the web-based intervention via an automated link sent by text message and email. The intervention consisted of an educational module designed to prepare the patient for their operation and provide support for their recovery through their choice of a smartphone-based application or an online portal. It also included patient-reported experience surveys preoperatively and postoperatively. Patients undergoing planned two-stage operations were assessed for engagement before their first operation. Descriptive analysis was performed to determine overall patient engagement rates, defined as completion of any portion of a patient-reported experience survey. Stratified analysis was performed comparing patients who did and did not engage with the intervention preoperatively.

Results/Outcomes: All 50 recruited patients engaged with the web-based intervention either preoperatively, postoperatively, or both. Overall, the median age was 59.8 years, 44% were male, 64% were White, and 58% underwent ostomy creation. Among adults who did not engage preoperatively, the median age was 63 years, 50% were male, 100% were White, and 0% underwent ostomy creation. Among those who engaged preoperatively, the median age was 58.6 years (p=0.92), 42.9% were male (p=0.71), 83.3% were White (p=0.67), and 81% underwent ostomy creation (p < 0.001). All three patients older than 80 years engaged preoperatively. Patients who did and did not engage came from a similar distribution of zip code income quartiles, with similar educational attainment and levels of access to smartphones and internet (Table 1).

Conclusion/Discussion: Patients engaged at high rates preoperatively with our web-based intervention. Income, education level, and smartphone and internet access were not identified as barriers in our study to preoperative engagement. Patients who did not undergo ostomy creation were less likely to engage perioperatively. Ongoing qualitative studies are evaluating underlying motives behind patient engagement with web-based interventions utilizing mobile health applications. Future work is needed to determine the impact of mental or functional status on engagement as well as the effectiveness of these web-based interventions for optimizing patients prior to rectal cancer surgery.

Table 1: Patient characteristics by preoperative engagement with the web-based intervention