Behaviours of older adults and caregivers preparing for elective surgery: a virtually conducted mixed-methods research protocol to improve surgical outcomes

Abstract

Introduction: Older adults (age ≥65 years) are pursuing increasingly complex, elective surgeries; and, are at higher risk for intraoperative and postoperative complications. Patients and their caregivers frequently struggle with the postoperative recovery process at home, which may contribute to complications. We aim to identify opportunities to intervene during the preoperative period to improve postoperative outcomes by understanding the preparatory behaviours of older adults and their caregivers before a complex, elective surgery.

Methods and analysis: As a result of the COVID-19 pandemic, we will conduct this study via telephone and videoconferencing. Using a multiphase mixed-methods research design, we will collect data on 10-15 patient-caregiver dyads from a pool of older adults (across a spectrum of cognitive abilities) scheduled for an elective colorectal surgery between 1 July 2020 and 30 May 2021. We will collect quantitative and qualitative data before (T1, T2) and after (T3, T4) surgery. Preoperatively, participants will each complete a cognitive assessment and a semi-structured qualitative interview that focuses on their preparatory behaviours (T1). They will then answer questionnaires about mood, self-efficacy and home environment (T2). Three weeks following hospital discharge, participants will complete another qualitative interview focusing on a comparison of preoperative and postoperative preparedness (T3). Researchers will also collect information about the patient's medical conditions, the postoperative complications and healthcare utilisation from the patient's chart 30 days following discharge (T4). We will code and conduct thematic analysis of the qualitative data to identify salient themes. Quantitative data will be analysed using basic descriptive statistics to characterise the participants. We will integrate the qualitative and quantitative findings using results from the quantitative scales to group participants and with use of joint display analysis.

Ethics and dissemination: Ethics approval was obtained from the University of Michigan IRB. Study findings will be disseminated through peer-reviewed journals and presentations at conferences.

Keywords: adult surgery; colorectal surgery; geriatric medicine; qualitative research; statistics & research methods.

Figure 1

Our conceptual model for understanding the preparatory behaviours of older adult–caregiver dyads. This is adapted from the health belief model, which helps to explain and predict health-related behaviours. Understanding underlying individual beliefs and modifying factors is considered essential to developing effective behavior-change interventions. For the current protocol, variables that are measured quantitatively are marked with a asterisk (*), while constructs explored qualitatively are marked with a circle (°).

Figure 2

Summary of qualitative and quantitative components and how we will integrate the findings to create a new understanding of preparatory behaviours of older adults and their caregivers. T1–T4 indicate the points in time that data will be collected. T1 and T2 are before the surgery. T3 (21 days after discharge home) and T4 (30 days after discharge) are during the postoperative period.

Figure 3

Flowchart indicating the four points in time during recruitment where we will assess eligibility. EMR, electronic medical record; MoCA, Montreal Cognitive Assessment.

Figure 4

Consent flow diagram. This figure depicts how we will use the Callahan 6 Item Screen to determine competency to consent. Scores of 4–6 points are considered ‘passing’ and thereby indicate competency to consent.