How can the use of digital technologies be optimised within surgical pathways to best support patients in making healthier lifestyle changes to improve surgical outcomes? : the results of three systematic reviews and three patient-informed qualitative studies

Abstract

There have been successful shifts toward the integration of digital technologies into clinical practice, benefitting clinicians and patients alike. Unanswered questions still remain regarding the optimisation of digital technologies when used by patients; specifically, to support lifestyle changes when undergoing bariatric, orthopaedic and cancer surgeries (Chapter 1). A systematic review of the existing quantitative literature was conducted to explore digital technology use during the aforementioned surgical specialities, with a focus on supporting lifestyle changes to be made (Chapter 2). Three knowledge gaps were identified: (i) the possibility of behavioural theory underpinning digital health technology design, (ii) the optimisation of design features to best suit patient needs, and (iii) the timing of digital health technology implementation and use during the surgical pathway. A second systematic review (meta-ethnography) was undertaken to synthesise important digital capabilities to support lifestyle change (Chapter 3), along with a literature review to identify current digital strategies in use (Chapter 4). Both reviews recognised a paucity of data identifying ‘optimal’ technology constituents from patient perspectives – thus, three patient-informed qualitative studies were conceptualised to address the knowledge gaps across bariatric, orthopaedic and cancer surgical cohorts. Chapter 5 details the methodology, research question, aims and objectives for this programme of work, while Chapters 6-8 detail the results, discussions and conclusions from the 54 pre- and post-operative participants involved. An overarching discussion and conclusion from the findings of the qualitative studies is included in Chapter 9. This research identified the importance of implementing person-centred approaches and including participant involvement in the ongoing development, optimisation and implementation of digital technologies in healthcare. Unique to each surgical cohort, underpinning features of technology were identified in order to optimally support behaviour change. These findings should be used to shape future co-design studies to inform healthcare providers, technology developers and further research in this area