A research team led by Dr. Jennifer Cracchiolo, MD, a surgeon at Memorial Sloan Kettering, recently developed a tool, “Goals to Discharge” (G2D), to support hospital-to-home discharge planning for patients with cancer. Her team merged the increasingly prevalent electronic patient-reported outcomes (ePROs) with best practices in discharge planning to create G2D. They reviewed 3,878 post-operative patients with either colorectal or thoracic cancer to determine the clinical uptake of the G2D tool. Their results, recently published in the Journal of Clinical Oncology – Oncology Practice, showed that despite moderate patient adoption, use reduced the risk of longer hospital stays.
The researchers worked with patients and caregivers to identify key post-surgery milestones that must occur before discharge, then repeated the process with clinicians. Once the G2D tool was built, it was implemented across surgery units. The tool was located in patients’ portals, and nurses oriented patients to it when they first arrived on the surgery floor. Patients used their personal devices to log into their patient portal at their own convenience and check off multiple milestones throughout their post-surgery hospital stay. The checklist included between ten and fourteen items, with items focused on ambulation and mobility, gastrointestinal tolerance, bowel function, pain management, and ability to engage in activities of daily living. Responses were immediately uploaded to patients’ medical records to help the surgical team monitor progress.
During the study period, 31% of patients completed at least one G2D survey. Adoption was higher among younger patients, those with a partner, those with English as a primary language, and those who had better pre-surgery health and fewer comorbidities. Patients were also more likely to use the G2D tool if they received formal patient education after surgery, suggesting the tool was discussed among nurses, social workers, and other educators. Compared with people who completed at least one G2D survey, those who did not complete a survey had a 3.7% lower risk of prolonged hospital stay (30% vs 23%).
The researchers conclude that the G2D tool achieved its goal of improving hospital length of stay, but that lower-than-expected adoption rates need to be addressed. The complexity of post-surgery care likely makes it hard for patients to take an active role in managing discharge preparation. Even though many patients want to take a more engaged role in their care, the physical, emotional, and social demands present after cancer surgery often make the move from passive to proactive difficult. While the G2D tool is one step toward better preparing patients, its integration into clinical workflows, particularly among oncology nurses and other care team members, can help ensure broader uptake and stronger communication between patients and clinical teams.