A multi- and mixed-method adaptation study of a patient-centered perioperative mental health intervention bundle

BMC Health Services Research

Research

Michael S. Avidan¹  Katherine J. Holzer¹  Alicia Meng¹  Joanna Abraham²  Emily Lenard³  Kenneth E. Freedland³  Eric J. Lenze³  Ana Baumann⁴  Mary C. Politi⁴ 

[1] Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;Institute for Informatics, Data Science and Biostatistics, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;

关键词: Surgery;    Tailoring;    Depression;    Anxiety;    Geriatric;    Psychiatry;    Wellness;    Anesthesia;   

DOI  :  10.1186/s12913-023-10186-3

 received in 2023-01-06, accepted in 2023-10-19,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAnxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients’ unique needs. As part of the feasibility trial, we developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication optimization (MO) to ameliorate anxiety and depressive symptoms before, during, and after cardiac, orthopedic, and oncologic surgery.MethodsWe used mixed-methods including workshop studios with patients, caregivers, clinicians, researchers, and interventionists; intervention refinement and reflection meetings; patient case review meetings; intervention session audio-recordings and documentation forms; and patient and caregiver semi-structured interviews. We used the results to refine our PMH bundle. We used multiple analytical approaches to report the nature of adaptations, including hybrid thematic analysis and content analysis informed by the Framework for Reporting Adaptations and Modifications – Expanded.ResultsAdaptations were categorized by content (intervention components), context (how the intervention is delivered, based on the study, target population, intervention format, intervention delivery mode, study setting, study personnel), training, and evaluation. Of 51 adaptations, 43.1% involved content, 41.2% involved context, and 15.7% involved training and evaluation. Several key adaptations were noted: (1) Intervention content was tailored to patient preferences and needs (e.g., rewording elements to prevent stigmatization of mental health needs; adjusting BA techniques and documentation forms to improve patient buy-in and motivation). (2) Cohort-specific adaptations were recommended based on differing patient needs. (3) Compassion was identified by patients as the most important element.ConclusionsWe identified evidence-based mental health intervention components from other settings and adapted them to the perioperative setting for older adults. Informed by mixed-methods, we created an innovative and pragmatic patient-centered intervention bundle that is acceptable, feasible, and responsive to the needs of older surgical populations. This approach allowed us to identify implementation strategies to improve the reach, scalability, and sustainability of our bundle, and can guide future patient-centered intervention adaptations.Clinical trials RegistrationNCT05110690 (11/08/2021).

【 授权许可】

CC BY   
© The Author(s) 2023

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