Authors (including presenting author) :
Sung HLS (1)
Affiliation :
(1)Department of Surgery, Tseung Kwan O Hospital, (2)The Nethersole School of Nursing, The Chinese University of Hong Kong
Introduction :
Surgical prehabilitation is a single or multi-disciplinary approach of exercises training, nutritional therapy and psychological counseling, with aims to improve physical fitness, strengthen cardiopulmonary function and reduce mental distress, through lifestyle modification and better physiological reserve prior to surgical procedure. However, the accessibility of regular out-patient supervised exercises and in-person nutritional counseling is very limited due to high caseloads of out-patient visits in context of short-handed physiotherapists and dietitian, and colorectal cancer patients are highly recommended to follow the unsupervised exercises and dietary regimen at home. Suboptimal regimen adherence toward these preoperative educations may result in poor surgical outcomes.
Mobile health (mHealth) has been all the rage in the recent research studies, especially in the pandemic of COVID-19, to deliver barrier-free health interventions at a reduced health cost. Behavioral change is the common goal of mHealth interventions impacted on enhanced regimen adherence through self-monitoring, prompt notification and customised educational content.
Objectives :
Leveraging the behavioral input and the research evidence, we aim to (1) provide an overview on the knowledge on model of behavior change, (2) and develop a theory-based digital prehabilitation for patient scheduling colorectal cancer surgery to enhance the treatment regimen and thus result in better patients' outcomes.
Methodology :
This paper provides an overview of model of Capacity, Opportunity, Motivation and Behavior (COM-B) to explain the behavioral input of digital prehabilitation, identify and critique the existing evidence of prehabilitation parallel with ERAS protocol, and incorporate the theory and research finding to develop a digital prehabilitation (WhatsApp-delivered) for patient scheduling colorectal cancer surgery.
Result & Outcome :
Capability refers to an individual’s physical and psychological capability to participate in the activities to achieve the designated outcomes. Given the high penetration of WhatsApp application in Hong Kong social media market, participants are expected to demonstrate a good knowledge of using WhatsApp without hesitation or with minimal guidance (physical capability). In the context of colorectal cancer, specific educational content towards physical vulnerabilities and dietary advice on cancer-related symptoms promotes the knowledge input. WhatsApp reminder message provides prompt multimedia reinforcement and supports regular self-monitoring by memory attention with behavior regulation. WhatsApp encompasses innovative features of instant text, voice and video message with easy and handy design which creates a better physical opportunity to sustain engagement. Virtual counselling (e.g. podcasting of peer-sharing on experiences and tips towards healthy lifestyle) encourages participants in engagement with the WhatsApp built-in professional support. Motivation is defined as automatic and reflective motivation that facilitate the willingness toward engagement. WhatsApp-assisted health intervention with a concrete action with structured timeframe (e.g. 30-minute relaxation breathing exercises) sustains the regular engagement through setting specific goal (e.g. sleep with at least 6 hours) and enhancing self-confidence.
In justification with the existing RCTs studies, elements of physical training (e.g. aerobic and resistance exericses) and psychological therapy (e.g. meditation) will be delivered through WhatsApp at three sessions (day 1, 3 & 5) per week for 30 minutes and 15 minutes respectively, educational information associated with colorectal cancer surgery (e.g. high risks factors towards surgical complications) and dietary advices (e.g. recipes) will be delivered on weekly basis (day 1).
Conclusion: concept of prehabilitation is embedded in this proposed digital innovation to align with the ERAS protocol where WhatsApp-delivered intervention is well-recognized in research evidence for enhanced adherence towards health education and promotion. Given the theoretical framework of utilizing digital intervention and research evidence of optimal patients’ outcomes under prehabilitation, it is aiming to enhancing the physical activity, nutritional status and psychological well-being for colorectal cancer patient scheduling for surgery. Further, this proposed programme could be the very first trial of digital prehabilitation in Hong Kong public hospital, therefore, it could act as the pioneer programme to explore the technology-incorporated prehabilitation for colorectal cancer patients with enhanced patients’ journey.
