The effectiveness and cost-effectiveness of ‘RecoverEsupport’, a Digital Health Intervention to support colorectal cancer patients prepare for and recovery from surgery: Study protocol of a randomised controlled trial

Abstract

Colorectal cancer (CRC) is the third most incident Australian cancer. Given many CRC patients are treated with surgery before continuing on to have chemotherapy or radiation therapies, there is a need to support patients to optimise their recovery. ‘Enhanced Recovery From Surgery’ (ERAS) guideline outlines patient-managed practices to reduce post-surgical complications and length of hospital stay (LoS), such as the rapid resumption of feeding and fluids, early mobilisation, and breathing exercises. However, patients need support to adhere to these guidelines, and a digital health intervention (DHI) may be an effective, cost-effective, and scalable solution. This protocol describes a study aiming to evaluate the effectiveness and cost-effectiveness of a DHI (RecoverEsupport) in increasing CRC surgical patients' adherence to the ERAS guidelines. Eligible patients will be recruited from the pre-operative clinics at two Newcastle Hospitals. Consenting patients will be randomised (1:1 ratio) to receive usual perioperative care (control) or RecoverEsupport (intervention). RecoverEsupport consists of a website and prompts directed to patients, clinicians and GPs to encourage patient self-management using evidence-based behaviour change strategies such as information provision, skills training, behavioural self-monitoring and feedback, and prompts and cues. Patients will complete online surveys at pre-admission, post-surgery, and post-discharge (1- and 3-months post-surgery). Outcomes are LoS (primary) assessed via medical records; Quality of Life (EORTC QLQ-C30), Quality of Recovery (QoR15), Days Alive and Out of Hospital (DAOH90), emergency department admissions, adherence to ERAS guidelines, and health care costs. If effective, the intervention could be rapidly scaled up and adapted for other surgical patient groups.