Prehabilitation

Who Needs Prehabilitation?

MCC patients are often more in need of prehabilitation than healthier patients to raise their baseline levels of health to surgery parameters and to increase their survival outcomes. This chart explores the branching pathways through which patients progress during the stages of perioperative health. Note that surgical patients either move forward to their surgeries (if they do not have significant conditions preventing them from doing so), or attend a prehabilitation program until they are qualified for surgery; if they did not reach their goal parameters, they would postpone surgery and restart the whole prehabilitation process. Time is on the right edge to indicate which stage the patient is going through.

Method

We conducted a qualitative study examining the surgical behaviors of MCC patients on HealingWell, an online health forum. The dataset was first filtered based on the 19 chronic conditions listed by the Center for Medicare and Medicaid Services (CMS). We applied a fuzzy search to find chronic conditions posts throughout the entire forum. Specifically, we constructed a chronic condition keyword-dictionary (CCKD) by tokenizing the words in the list provided by CMS.

To limit noise in the data, each user in the dataset needed to have posted at least 3 times in at least 2 different categories, and the length of time between the first and last posts needed to exceed 365 days. We then narrowed our focus by using surgery-related words for a secondary filtration. Our final dataset included 154 unique users and 602 threads, spanning from 7/2005 to 11/2016. Among 602 threads that met our criteria, the category with the most posts in our dataset is prostate cancer, which has 228 posts, and the least discussed condition is Alzheimer's disease with 7.

Results

Surgical patients with MCC often face complications and challenges which stem from across three orders. Although simplified from the complex reality of chronic condition management, we present a model to demonstrate a more holistic interpretation of MCC patients' surgical care needs.

First, MCC patients experience the primary complications of their chronic conditions, which includes symptoms and challenges specific to the condition. Next, secondary complications arise from the surgery itself, and can include fear, infections, and a need for new medications or side-effects to new medications. Finally, patients may experience tertiary emotional complications, which include tensions with family, friends, and career peers which result from the above complications. This theoretical hierarchy of complications demonstrates the degrees of complications a patient may experience, and it should illustrate the interrelatedness of these issues. through.