Digital health innovations to optimize perioperative care in major abdominal surgical procedures
Authors:   , den Bakker Chantal Michelle 
Published: May 2024

The objective of this thesis is to contribute to the development, adjustment and evaluation of improving postoperative recovery following major abdominal (cancer) surgical procedures with more emphasis on the further development and evaluation of the personalized eHealth program (‘IkHerstel). In Chapter two, a focus group study on experiences of recovery and unmet needs in different treatment phases as perceived by colon cancer patients who had surgical treatment and adjuvant chemotherapy is presented. Possible solutions for unmet needs by eHealth were explored and have been used to complete Chapter three. This Chapter describes the development of the recovery orientated eHealth intervention ‘IkHerstel’ using the Intervention Mapping protocol, in which the study protocol is obtained. Chapter four presents the results of the randomized controlled trial, in which the effectiveness of the ‘IkHerstel’ intervention on return to normal activities for patients who underwent major abdominal surgical procedures (i.e. laparoscopic or abdominal colectomy or hysterectomy) is presented. In Chapter five a mixed method process evaluation of the randomized controlled trial of the ‘IkHerstel’ intervention of patients after colorectal surgical procedures is described. The intervention applicable for colon cancer patients is evaluated and advice for future adaption and implementation is given. An overview of potentially relevant prognostic factors for return to work or work disability amongst colorectal cancer survivors is given in Chapter six. In Chapter seven, an overview of the total duration until return to work and all reasons for ending the sick leave period of colorectal cancer patients within one Occupational Health Service in the Netherland is given. Furthermore, the development and internally validation of two prediction models for return to work at 1 and 2 year after the start of the sick leave period of colorectal cancer patients are described. The main findings of this thesis were summarized in Chapter eight and research questions were answered. This thesis contributes to the development, adjustment and evaluation of postoperative recovery following major abdominal (cancer) surgical procedures with more emphasis on the further development and an evaluation of a personalized eHealth program using personalized PROMs including goal attainment scaling. It proved effective for the purpose of shortening time to return to normal activities after major abdominal (cancer) surgery with almost two weeks. Further, methodologic considerations of the different studies were discussed. A few adaptations to the intervention will help to optimize implementation in daily practice. This eHealth program should be more blended with standard care, more flexible (e.g. in case of complications) and should be able to respond to patients’ emotional and cognitive needs. Furthermore, there should be more attention for return to work of cancer patients. A solution could be to better integrate occupational health with clinical cancer care in daily practice.