Smartphone app may help implement ERAS protocols for radical cystectomy

Findings presented during the 2020 Society of Urologic Oncology Annual Meeting showed high patient satisfaction with a smartphone-based app intended to facilitate the implementation of enhanced recovery after surgery (ERAS) protocols following radical cystectomy (RC).¹

“Given the tremendous anxiety and information overload that patients feel before and after RC, smartphone-based apps represent an opportunity to enhance communication between patients and care teams,” wrote the researchers. “In light of the current COVID pandemic, they may also afford an opportunity to decrease reliance on in-person visits in the pre-operative and post-operative period.”

From March 10 to July 2020 the study enrolled 27 patients undergoing RC, and encouraged them to register with Seamless MD, a digital platform that can be accessed by smartphone or computer. Of those patients, 17 (63%) participated in the Seamless MD pilot, with 14 patients (82.4%) completing the program, and 3 patients still within 30 days of surgery.

Electronic educational materials were distributed to patients via smartphone notifications, and preoperative prompts and instructions were sent to patients in the weeks leading up to their surgery. Post-operatively, activity reminders and questionnaires were sent to optimize recovery trajectory and assess symptom burden. Questions covered issues such as daily self-reported pain and ambulatory and anxiety levels.

Among the 6 patients who completed all pre-operative learning modules and answered all post-operative questionnaires, 4 reported that Seamless MD prevented at least 1 phone call to the clinic, with 1 patient reporting that it prevented a visit to the hospital.

An additional post-program survey was completed by 7 patients. The responses to those questions yielded the following results:

• 100% of patients said Seamless MD helped them feel more confident before surgery
• 57.1% of patients said Seamless MD helped them feel more confident during hospitalization
• 83.3% of patients said Seamless MD helped them feel more confident at home after surgery

Additionally, use of the Seamless MD app helped alleviate patients’ fears, as 85.7% indicated that Seamless MD helped them feel less worried before surgery, and 71.4% noted Seamless MD helped them feel less worried during hospitalization.

ERAS protocols are known to be integral to successful recovery following RC, and the researchers noted that central to those protocol were pre-operative counseling and post-operative monitoring.

“Cognizant of social distancing during the COVID-19 era, we sought to replace traditional materials and post-operative visits with a smartphone-based application,” they wrote.

Despite the small study size, the researchers believe that the study results were promising, and continued integration of technology would be beneficial to patients undergoing RC.

“We are hopeful that with wider integration into existing care pathways, smartphone-based apps will allow more efficient tracking of patient recovery at home, and lead to earlier detection and even prevention of post-RC complications.”

Reference

1. Hockman L, Chow C, Skinner E, Shah JB. ERAS in The COVID Era: Using Smartphone Technology for Preoperative Counseling/Optimization and Post-operative Symptom Monitoring. Presented at: 21st Annual Meeting of the Society of Urologic Oncology; December 3, 2020. Poster 49.