Introduction:

Enhanced recovery after surgery (ERAS) protocols are integral to the care of patients undergoing radical cystectomy (RC). While protocols differ in specific components, central to all ERAS efforts are effective preoperative counseling and post-operative monitoring. Most institutions rely on traditional paper-based educational materials for pre-operative counseling and conventional in-person visits for post-operative monitoring. Cognizant of the risks conferred by in-person visits to both patients and health care workers in the COVID era, we sought to determine if a smartphone-based application could be used to successfully communicate with patients undergoing RC. In this pilot study, we report on the feasibility and patient acceptability of this novel communication method.

Methods:

Patients undergoing RC at our institution between March and July 2020 were encouraged to register with Seamless MD, a digital platform that can be accessed by a smartphone application (app) or by computer. All pre-operative educational materials were uploaded onto the SeamlessMD server and distributed to patients via smartphone notifications using a “just-in-time” strategy. Patients were provided with educational prompts and instructions at the most appropriate time in the weeks leading up to their surgery. In the post-operative period, patients received automated activity reminders as well as time-point specific questionnaires to assess each patient’s symptom burden and recovery trajectory. Questions covered issues such as daily self-reported pain scores, oral intake, ambulation and anxiety levels. Questions also assessed level of patient satisfaction with the SeamlessMD platform.

Results:

Of the 27 patients who underwent RC during the study time period, 17 (63%) participated in the SeamlessMD pilot. Of those 17 participants, 14 (82.4%) have completed the program and 3 are still within 30 days of surgery. Six of those 14 patients (42.8%) successfully completed all preoperative learning modules and answered all postoperative questionnaires. Of those 6 patients, 4 (66.7%) reported that SeamlessMD prevented at least 1 phone call to the clinic, 1 (16.7%) reported that it prevented a visit to the hospital. Five of the 6 patients (83.3%) who completed the post-program survey reported that they would highly recommend the application to other patients. See Table 1 below for additional responses related to the patient satisfaction surveys.

Conclusion:

Given the tremendous anxiety and information overload that patients feel before and after RC, smartphone-based apps represent an opportunity to enhance communication between patients and care teams. In light of the current COVID pandemic, they may also afford an opportunity to decrease reliance on in-person visits in the pre-operative and post-operative period. We are hopeful that with wider integration into existing care pathways, smartphone-based apps will allow more efficient tracking of patient recovery at home, and lead to earlier detection and even prevention of post-RC complications.

Funding: N/A