Roshni Alam1, Joel Montanez2, Susan Law2, Lawrence Lee1, Nancy Mayo3, Liane Feldman1, Julio Fiore Jr1. 1Department of Surgery, McGill University, 2St Mary’s Research Centre, 3School of Physical and Occupational Therapy, McGill University
INTRODUCTION: Patient-reported outcome measures (PROMs) are central to determining the value of interventions that aim to improve surgical recovery. However, the evidence underpinning the PROMs currently in use to assess recovery after abdominal surgery is relatively weak, and the scientific contribution to the measurement properties is limited. To bridge this knowledge gap, we recently initiated a research program to develop a conceptually relevant and psychometrically sound recovery-specific PROM. In compliance with FDA recommendations for PROM development, the first stage of this program aims to develop a conceptual framework representing the health domains relevant to the process of recovery after abdominal surgery.
METHODS AND PROCEDURES: A systematic review was undertaken to identify PROMs currently used in the context of recovery after abdominal surgery. All items contained in the PROMs were categorized into health domains covered by the International Classification of Functioning, Disability and Health (ICF). To acquire expert input, 35 perioperative care experts from SAGES and ERAS Society were invited to participate in a 2-round Delphi study in which they rated their agreement with each domain. Domains deemed as relevant (>75% agreement) were organized into a diagram comprising a hypothesized conceptual framework of recovery after abdominal surgery. Qualitative interviews with abdominal surgery patients, guided by the hypothesized conceptual framework, were planned (and are in progress) at 5 international sites (Canada, USA, Japan, Italy and Brazil) to derive the final conceptual framework. These interviews focus on patients’ lived experiences after abdominal surgery, are analyzed according to a modified grounded theory approach, and will continue until thematic saturation is reached.
RESULTS: The systematic review identified 19 PROMs covering 66 ICF domains. 23 experts (66%) participated in the Delphi process. After Round 2, experts agreed that 22 health domains are potentially relevant to the process of recovery after abdominal surgery (Figure; blue). Thus far, the analysis of 4 Canadian interviews has validated these 22 initially hypothesized domains and has added 5 domains into the conceptual framework (Figure; beige).
CONCLUSION: This conceptual framework is an essential first step in our research program leading to a novel recovery-specific PROM to be used in research informing patient-centered decision-making as well as quality improvement initiatives in the field of abdominal surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86280
Program Number: S130
Presentation Session: ERAS Session
Presentation Type: Podium