Avaliação do impacto do programa Enhanced Recovery After Surgery (ERAS) no manejo perioperatório em mulheres com câncer ginecológico.
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2022-01-28
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Universidade Estadual Paulista (Unesp)
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Introdução: O programa Enhanced Recovery After Surgery (ERAS) tem sido adotado em várias especialidades cirúrgicas e instituições em todo o mundo e as evidências do seu benefício na Ginecologia Oncológica estão bem estabelecidas. O programa ERAS concentra-se nos pacientes e no recebimento de cuidados baseados em evidências. Como fonte de motivação para as pacientes, acredita-se que ferramentas digitais possam contribuir para a mudança de comportamento e maior engajamento dos pacientes a participarem mais ativamente do seu processo de recuperação. A gamificação pode ser um meio eficaz de direcionar componentes motivacionais. Esta tese tem como objetivo uma revisão da literatura com as recomendações do manejo peri-operatório em cirurgia ginecológica baseadas no programa ERAS e o desenvolvimento e validação de um aplicativo (app) móvel gamificado para utilização por pacientes no pós-operatório, com base no programa ERAS. Métodos: Foram revisados os protocolos mais atuais publicados pela ERAS Society. O processo de desenvolvimento do app (MobERAS) incluiu idealização; formação de equipe interdisciplinar; avaliação da necessidade potencial dos usuários; e desenvolvimento e implantação do produto. Testes de usabilidade foram realizados durante o processo de desenvolvimento. Foi realizada a validação do app, com a inclusão de mulheres submetidas a cirurgias ginecológicas oncológicas de médio e grande porte. As pacientes avaliaram a usabilidade do app por meio da System Usability Scale (SUS). Utilizou-se a Mobile App Rating Scale (MARS) para avaliação do MobERAS por profissionais de saúde e profissionais em tecnologia. Foi realizada uma coleta de dados com o uso do MobERAS referentes a desfechos clínicos ocorridos nas primeiras 24 horas do pós-operatório, e então realizada uma análise, com avaliação de associações desses dados com parâmetros do programa ERAS. As diferenças com p<0,05 foram consideradas significantes. Resultados: Foi realizada uma revisão da literatura com as recomendações do manejo perioperatório em cirurgia ginecológica baseado no programa ERAS. Foi desenvolvido um app gamificado baseadas nessas recomendações. O MobERAS foi de fácil utilização e atraente devido ao uso de gamificação. Foi projetado para ser baixado em dispositivos móveis e para fornecer dados pós-operatórios. Foi acoplado a ele um sistema de posicionamento global (GPS) que monitora o tempo e a distância de deambulação. Houve uma boa aceitação do uso do MobERAS pelas pacientes, com boa avaliação da usabilidade. O app foi avaliado em todos os quesitos como bom ou muito bom pelos profissionais. Um maior tempo de imobilidade no pós-operatório se associou significativamente com a ocorrência de vômitos (p=0,001), não eliminação de flatos (p=0,004) e pior tolerância à dieta nas primeiras 24 horas (p<0,001). Um tempo mais prolongado desde o término da cirurgia até a primeira caminhada se associou significativamente com uma pior a tolerância à dieta (p<0,001). Evidenciou-se ainda associação significativa de um maior índice de dor com não eliminação de flatos (p=0,014) e pior tolerância à dieta (p=0,019). Conclusão: O programa ERAS deve se tornar a prática padrão nas cirurgias ginecológicas eletivas. O MobERAS se mostrou de fácil utilização, seguro, bem aceito pelas pacientes e bem avaliado por especialistas.
Introduction: The “Enhanced Recovery After Surgery (ERAS)” program has been adopted in various surgical specialties and institutions around the world and the evidence for its benefit in Gynecologic Oncology are well established. The ERAS program focuses on patients and receiving evidence-based care. As a source of motivation for the patients, it is believed that digital tools can contribute to behavior change and a greater engagement of patients to participate more actively in their recovery process. The gamification may be an effective way of driving motivational components. This thesis aims to review the literature with the recommendations of the perioperative management in gynecological surgery based on the ERAS program and the development and validation of a gamified mobile application (app) for use by patients in the postoperative period, based on the ERAS program. Methods: The most current protocols published by the ERAS Society were reviewed. The app development process (MobERAS) included ideation; the formation of an interdisciplinary team; the assessment of potential user needs; and product development and deployment. Usability tests were performed during the development process. The app was validated with the inclusion of women undergoing medium and major gynecologic oncologic surgeries. The patients evaluated the app's usability using the System Usability Scale (SUS). The Mobile App Rating Scale (MARS) was used to evaluate the MobERAS by healthcare and technology professionals. Data was collected with the use of MobERAS referring to clinical outcomes occurring in the first 24 hours postoperatively, and then an analysis was performed, with evaluation of associations of these data with parameters of the ERAS program. Differences with p<0.05 were considered significant. Results: A literature review was conducted with recommendations for the perioperative management in gynecologic surgery based on the ERAS program. A gamified app was developed based on these recommendations. The MobERAS was user-friendly and attractive due to the use of gamification. It was designed to be downloaded on mobile devices and to provide postoperative data. It was coupled with a global positioning system (GPS) that monitors walking time and distance. There was a good acceptance of the use of MobERAS by the patients, with good evaluation of the usability. The app was rated as good or very good by the professionals. A longer time of immobility postoperatively was significantly associated with the occurrence of vomiting (p=0.001), non-elimination of flatus (p=0.004) and worse tolerance to diet in the first 24 hours (p<0.001). A longer time from the end of surgery to the first walk was significantly associated with worse diet tolerance (p<0.001). There was also significant association of a higher pain index with non-elimination of flatus (p=0.014) and worse diet tolerance (p=0.019). Conclusion: The ERAS program should become standard practice in elective gynecologic surgeries. The MobERAS proved to be easy to use, safe, well accepted by patients and well evaluated by specialists.
Introduction: The “Enhanced Recovery After Surgery (ERAS)” program has been adopted in various surgical specialties and institutions around the world and the evidence for its benefit in Gynecologic Oncology are well established. The ERAS program focuses on patients and receiving evidence-based care. As a source of motivation for the patients, it is believed that digital tools can contribute to behavior change and a greater engagement of patients to participate more actively in their recovery process. The gamification may be an effective way of driving motivational components. This thesis aims to review the literature with the recommendations of the perioperative management in gynecological surgery based on the ERAS program and the development and validation of a gamified mobile application (app) for use by patients in the postoperative period, based on the ERAS program. Methods: The most current protocols published by the ERAS Society were reviewed. The app development process (MobERAS) included ideation; the formation of an interdisciplinary team; the assessment of potential user needs; and product development and deployment. Usability tests were performed during the development process. The app was validated with the inclusion of women undergoing medium and major gynecologic oncologic surgeries. The patients evaluated the app's usability using the System Usability Scale (SUS). The Mobile App Rating Scale (MARS) was used to evaluate the MobERAS by healthcare and technology professionals. Data was collected with the use of MobERAS referring to clinical outcomes occurring in the first 24 hours postoperatively, and then an analysis was performed, with evaluation of associations of these data with parameters of the ERAS program. Differences with p<0.05 were considered significant. Results: A literature review was conducted with recommendations for the perioperative management in gynecologic surgery based on the ERAS program. A gamified app was developed based on these recommendations. The MobERAS was user-friendly and attractive due to the use of gamification. It was designed to be downloaded on mobile devices and to provide postoperative data. It was coupled with a global positioning system (GPS) that monitors walking time and distance. There was a good acceptance of the use of MobERAS by the patients, with good evaluation of the usability. The app was rated as good or very good by the professionals. A longer time of immobility postoperatively was significantly associated with the occurrence of vomiting (p=0.001), non-elimination of flatus (p=0.004) and worse tolerance to diet in the first 24 hours (p<0.001). A longer time from the end of surgery to the first walk was significantly associated with worse diet tolerance (p<0.001). There was also significant association of a higher pain index with non-elimination of flatus (p=0.014) and worse diet tolerance (p=0.019). Conclusion: The ERAS program should become standard practice in elective gynecologic surgeries. The MobERAS proved to be easy to use, safe, well accepted by patients and well evaluated by specialists.
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Recuperação pós-cirúrgica melhorada, Período pós-operatório, Câncer ginecológico, Aplicativos móveis, Telemedicina, Enhanced recovery after surgery, Postoperative period, Genital neoplasms, female, Mobile applications, mHealth