Scalable Digital Communication Intervention to Support Older Adults and Care Partners Transitioning Home After Major Surgery

Adults aged 65 years and older account for over 40 percent of inpatient operations performed in the United States. After surgery, these patients often experience functional decline, anxiety, sleep disturbance, and loss of independence upon transitioning home, increasing the strain on family and care partners, and contributing to adverse outcomes. Providing patients with timely post-discharge information and interdisciplinary communication can reduce readmissions, increase adherence to discharge recommendations, and relieve patient and family stress. While surgeons try to support these patients through the perioperative transitions, most are not trained to address geriatric needs. These gaps can be filled with smartphone-based education and remote self-monitoring, both of which are scalable solutions that address poor care coordination and unmet information needs for patients transitioning home after major surgery.

This research will develop and evaluate the Perioperative Optimization of Senior Health intervention, also known as myPOSH, a mobile application (app) to improve integration of geriatric principles into surgical care. myPOSH is a virtual coach meant to improve patient and care partner quality of life during post-surgical transitions by addressing patient-prioritized health outcomes and improving communication between providers and patients and their care partner. The app will also include remote monitoring and real-time education, helping patients understand their recovery trajectory and support critical communication. Surveys will allow patients and care partners to tailor app content based on real-time symptoms and symptom severity.

The specific aims of the research are as follows:

• Define the unmet education and communication needs of older adults and their care partners when preparing for and recovering from transitions between the hospital and home to create a scalable solution.
• Evaluate usability and acceptability of myPOSH in two surgical clinics to refine the intervention while considering scalability across surgical settings.
• Determine feasibility of a multisite randomized controlled trial (RCT) of myPOSH relative to usual surgical care.

The study team will interview up to 30 older adults undergoing major surgery and their care partners, and conduct four focus groups with surgeons, geriatricians, and nurses to inform the development of the app content and methodology. They will then evaluate usability and refine myPOSH using assessments and interviews from a pilot of 20 patients and two surgical teams. Finally, the researchers will conduct an RCT of 84 patients at two surgical sites: a large academic hospital and a community hospital, to examine the feasibility and acceptability of myPOSH versus usual surgical care, app efficacy, and stakeholder engagement. The mobile app will continue during the transition home after surgery, providing assessments and educational content to support patients and care partners during this transition. Involving care partners in the intervention will ensure that they receive the support needed to reduce care-partner strain during transitions home after surgery.

Experiences gained through this research will guide future research to improve caregiver preparedness and reduce patient anxiety in the perioperative setting. The findings from this work can be scaled and adapted for many health conditions and will drive future efforts to improve post-surgical transitions to the patient home.