Designing person-centred technologies to support patients undergoing cancer surgery: a pharmacist-led, qualitative study
Authors: Robinson-Barella A , Husband A , Slight R , Slight S 
Published: November 2022

Abstract

Introduction
Lifestyle changes made during the pre-operative period can positively influence post-operative outcomes and the overall success of cancer surgeries.1 Digital technologies (including smartphone apps and fitness trackers) which support patients with physical activity and rehabilitation advice present an opportunity to support surgical patients remotely.2 However, little is known about the best way to design or provide these digital technologies in a person-centred manner. In order to develop effective digital strategies for this unique patient cohort, it is important to first understand in what way(s) do cardiothoracic cancer surgery patients want to be supported with technology.3

Aim
To understand how digital technologies could be designed and delivered to better support patients undergoing cancer surgery, specifically: 1) what support do patients want from technologies, 2) how do they want to use them, and 3) when should they be implemented pre- and/or post-operatively?

Methods
The EQUATOR guidelines and COREQ checklist were followed. Pre- and post-operative patients attending cardiothoracic cancer surgery clinics within one large teaching hospital in the North of England were invited to take part. Purposive sampling was employed to recruit a representative sample of patients. Semi-structured interviews took place between September 2020-February 2021, during the coronavirus pandemic; interviews were conducted over the telephone or via video call-based software, and were audio-recorded and transcribed verbatim. Interviews included questions on participant surgical experience, behaviour change and perspectives on digital technologies. Reflexive thematic analysis enabled the development of themes from the data. QSR NVivo software (Version 12) facilitated data analysis. The Newcastle University Patient and Public Involvement and Engagement group had extensive input in the study design and conceptualisation. Ethical approval was obtained from the NHS Health Research Authority (HRA) and Care Research Wales (reference: 19/NE/0318).

Results
Sixteen participants were recruited; these included 9 females, with 6 interviews being ran via Zoom®, and an average age for all participants of 65-years (SD 8.29). Four themes were developed from the data that related to the design and delivery of person-centred technologies in order to best meet the needs of patients undergoing cardiothoracic cancer surgery; these centred on: (i) “getting the technology to tell me, guide me and encourage me”; (ii) “tracking me and supporting me to reach my goals”; (iii) “feeling comfort in knowing I’m not alone”; and (iv) “getting the timing right for me”.

Discussion/Conclusion
This study is one of the first in this patient cohort to involve pre- and post-operative participants. It provides key insights to address knowledge gaps relating to the design and optimisation of person-centred digital technologies for patients undergoing surgery for cardiothoracic cancer. We acknowledge some limitations with our work; whilst we did not sample participants by socioeconomic status, it is possible that different socioeconomic classes may have varied experiences with technologies. Our focus was solely cardiothoracic cancer surgery and thus findings may not be generalisable to other surgical procedures. These findings have the potential to shape and influence future work on the co-design and optimisation of person-centred digital health technologies in modern healthcare settings.

References
1. Silver JK, et al. Cancer rehabilitation may improve function in survivors and decrease the economic burden of cancer to individuals and society. Work, 2013, 46(4):455-472.
2. Robinson A, et al. The effectiveness of digital technologies to support surgical patients in changing their health behaviours: a systematic review. BJS Open, 2021. DOI: 10.1093/bjsopen/zraa009.
3. Robinson A, et al. Digital and mobile technologies to promote physical health behaviour change and provide psychological support for elective surgical patients: a meta-ethnography and systematic review. JMIR mHealth and uHealth, 2020. 8(12): e19237. DOI: 10.2196/19237.