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Designing for impact: identifying stakeholder-driven interventions to support recovery after major cancer surgery

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Complex bladder and colorectal cancer surgeries are associated with significant patient morbidity, yet few resources exist to prepare patients for the high levels of distress and complications they may experience. After ethnographic research to identify design challenges, we held a user-centered design (UCD) workshop to begin to develop patient- and caregiver-centered interventions to support preparation for and recovery after complex cancer surgery.

Methods

Concepts that emerged from brainstorming sessions were visually represented on storyboards and rated. Highly scored concepts were further developed in break-out prototyping sessions and then presented to the entire group for review in person and during subsequent webinars. We collected workshop products (worksheets, prototypes, and recordings) for analysis to identify opportunities for intervention. The workshop, held in late 2014, was attended by three colorectal/oncologic surgeons, three urologic surgeons, five ostomy nurses, one quality improvement leader, three patients, one caregiver, and three experienced UCD facilitators.

Results

Three opportunity areas were identified: (1) enhanced patient education including tele-health and multi-media tools (available at hospitals/clinics or online in any setting), (2) personalized discharge assessment and care planning, and (3) integrated symptom monitoring and educational interventions. Stakeholders reached consensus that enhanced patient education was the most important direction for subsequent intervention development.

Conclusions

We engaged diverse stakeholders in a participatory, UCD process and concluded that research and practice improvement should prioritize the development of educational interventions in the pre-operative period to set the groundwork for improving appropriate self-care during recovery from major colorectal and bladder cancer surgeries.

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Acknowledgements

We are grateful to the Garfield Innovation Center for providing coaching and a wonderful facility for creative thinking. We also thank the patients and caregivers who attended our workshop for their insights and guidance.

Source of Funding

This work was supported by the Kaiser Permanente Garfield Innovation Center, San Leandro, CA and NCI (Bethesda, MD) R01 CA164128 (McMullen, PI).

Author information

Authors and Affiliations

  1. Center for Health Research - Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA

    Carmit McMullen & Alison Firemark

  2. School of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Matthew Nielsen & Michael Meyers

  3. IDEO, San Francisco, CA, USA

    Patricia Merino Price

  4. Kaiser Permanente Northern California, Oakland, CA, USA

    Denise Nakatani, Jean Tuthill & Ruth McMyn

  5. Department of Urology, University of Washington, Seattle, WA, USA

    Anobel Odisho

  6. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    David Shibata

  7. Moffitt Cancer Center, Tampa, FL, USA

    Scott Gilbert

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  1. Carmit McMullen
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  2. Matthew Nielsen
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Corresponding author

Correspondence to Carmit McMullen.

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Conflict of interest

Dr. Nielsen serves on the Medical Advisory Board for Grand Rounds, Inc. No other conflicts of interest have been declared.

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McMullen, C., Nielsen, M., Firemark, A. et al. Designing for impact: identifying stakeholder-driven interventions to support recovery after major cancer surgery. Support Care Cancer 26, 4067–4076 (2018). https://doi.org/10.1007/s00520-018-4276-0

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  • DOI: https://doi.org/10.1007/s00520-018-4276-0

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