Smartphone-based Assessment of Preoperative Decision Conflict and Postoperative Physical Activity Among Patients Undergoing Cancer Surgery

Autor: Stuart R. Lipsitz, Carrie C. Lubitz, Emily Huang, Alex B. Haynes, Eesha V Desai, Ian Solsky, Nikhil Panda, Evan M. Benjamin, Christy E. Cauley, Jukka-Pekka Onnela
Rok vydání: 2020
Předmět:
Zdroj: Annals of Surgery. 276:193-199
ISSN: 1528-1140
0003-4932
DOI: 10.1097/sla.0000000000004487
Popis: Objective To determine the prevalence of clinically significant decision conflict (CSDC) among patients undergoing cancer surgery and associations with postoperative physical activity, as measured through smartphone accelerometer data. Background Patients with cancer face challenging treatment decisions, which may lead to CSDC. CSDC negatively affects patient-provider relationships, psychosocial functioning, and health-related quality of life; however, physical manifestations of CSDC remain poorly characterized. Methods Adult smartphone-owners undergoing surgery for breast, skin-soft-tissue, head-and-neck, or abdominal cancer (July 2017-2019) were approached. Patients downloaded the Beiwe application that delivered the Decision Conflict Scale (DCS) preoperatively and collected smartphone accelerometer data continuously from enrollment through 6 months postoperatively. Restricted-cubic-spline regression, adjusting for a priori potential confounders (age, type of surgery, support status, and postoperative complications) was used to determine trends in postoperative daily physical activity among patients with and without CSDC (DCS score≥25/100). Results Among 99 patients who downloaded the application, 85 completed the DCS (86% participation rate). Twenty-three (27%) reported CSDC. These patients were younger (mean age 48.3 [standard deviation 14.2]-vs.-55.0 [13.3],p = 0.047) and more frequently lived alone (22%-vs.-6%,p = 0.042). There were no differences in preoperative physical activity (115.4 minutes [95%CI 90.9,139.9]-vs.-110.8 [95% 95.7,126.0],p = 0.753). Adjusted postoperative physical activity was lower among patients reporting CSDC at 30 days (difference 33.1 minutes [95%CI 5.93,60.2],p = 0.017), 60 days (35.5[95%CI 8.50,62.5],p = 0.010) and 90 days (31.8[95%CI 5.44,58.1],p = 0.018) postoperatively. Conclusions CSDC was prevalent among patients who underwent cancer surgery and associated with lower postoperatively daily physical activity. These data highlight the importance of addressing modifiable decisional needs of patients through enhanced shared decision-making.
Databáze: OpenAIRE
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