To compare the effectiveness of two approaches for managing patient-reported symptoms after ambulatory cancer surgery in reducing unplanned emergency department (ED) visits and increasing patient well-being
||Randomized controlled trial
||2,624 patients ages 18 and older undergoing ambulatory surgery for breast, gynecologic, urologic, or head and neck cancer and 1,099 caregivers
- Team monitoring
- Enhanced feedback
Primary: unplanned ED visits that do not result in hospital admission, frequency of readmission, surgical adverse events, symptom-triggered interventions (calls to nurses after surgery and referrals to pain management specialists)
Secondary: patient engagement (measured by the Patient Activation Measure) and anxiety; caregiver burden
||1-month follow-up for primary outcomes
This randomized controlled trial compared the effectiveness of two methods—team monitoring versus enhanced feedback—for managing patient-reported symptoms after ambulatory cancer surgery in reducing unplanned ED visits, patient anxiety, caregiver burden, and surgical adverse events and increasing patient engagement.
Researchers randomized patients to one of the two approaches. In both approaches, patients completed an online survey about their level of symptoms each day for 10 days after surgery. After completing each survey, patients received information to help manage their symptoms in one of two ways:
- Team monitoring. Healthcare providers contacted patients by phone if the patients reported any symptoms above a certain threshold on their survey.
- Enhanced feedback. Patients received a report immediately after finishing their survey that showed their own symptom data compared with data from patients who had similar surgeries.
All patients received notification to seek medical attention immediately after survey completion if their symptoms were too severe.
Researchers reviewed electronic medical records to track the number of ED visits, hospital readmissions, adverse surgical events, and patient calls with nurses for 30 days after surgery. At 14 and 60 days following surgery, patients completed a survey about engagement and caregivers completed a survey about burden. Patients’ daily surveys included questions about anxiety.
The study included 2,624 patients undergoing ambulatory cancer surgery in New York City and their caregivers. Of these patients, 81% were White, 6% were African American, 6% were Asian, and 3% were another race; 7% were Hispanic. The average age was 54, and 72% were female.
Patients, caregivers, clinicians, researchers, and hospital staff helped inform the design and conduct of the study.
The two approaches did not differ significantly in the proportion of patients who sought care at the ED one month after surgery or in readmission frequency, surgical adverse events, pain management referrals within one month, or patient engagement or caregiver burden within two months of surgery. However, patients who received enhanced feedback made 10% fewer nursing calls 30 days after surgery than patients who received team monitoring (p<0.001).
Patients who received enhanced feedback also had a quicker reduction in anxiety than patients who received team monitoring (p<0.001).
Patients who have surgery at ambulatory cancer centers are generally healthier and have less complex post-surgical follow-up needs than patients who have cancer surgery in hospital settings. The results may not apply to patients in other settings.
Conclusions and Relevance
In this study, the two approaches did not differ in reducing ED use after cancer surgery, but the enhanced feedback approach reduced patient calls to nurses and reduced patient anxiety faster than team monitoring.
Future Research Needs
Future research could test the enhanced feedback intervention with patients who have more complex surgical needs.