Patient motivators of postoperative electronic patient-reported outcome symptom monitoring use in thoracic surgery patients: a qualitative study.

BACKGROUND: Electronic patient-reported outcome (ePRO) systems can be used to engage patients in remote symptom monitoring to support postoperative care. We interviewed thoracic surgery patients with ePRO experience to identify factors that influenced use of ePROs to report their symptoms post-discharge. METHOD: This qualitative study used semi-structured telephone interviews with adults who underwent major thoracic surgery at an academic medical center in North Carolina. Individuals who enrolled in symptom monitoring, completed at least one ePRO survey, and were reachable by phone for the interview were included. The ePRO surveys assessed 10 symptoms, including validated Patient-Reported Outcome Common Terminology Criteria for Adverse Events (PRO-CTCAE) measures and thoracic surgery-specific questions. Surveys, offered via web-based and automated telephone options, were administered for four weeks post-discharge with alerts sent to clinicians for concerning symptoms. The interviews were guided by the Capability, Opportunity, Motivation model for behavior change (COM-B) and examined factors that influenced patients' completion of ePRO surveys post-discharge. Team members independently coded interviews and identified themes, informed by COM-B. We report descriptive statistics (demographics, number of surveys completed) and themes organized by COM-B components. RESULTS: Of 28 patients invited, 25 (89%) completed interviews from July to October 2022. Participants were a median 58 years, 56% female, 80% White, and 56% had a history of malignancy. They completed 131/150 (87%) possible ePRO surveys. For capability, participants reported building ePROs into their routine and having the skills and knowledge, but lacking physical and emotional energy, to complete ePROs. For opportunity, participants identified the ease and convenience of accessing ePROs and providers' validation of ePROs. Motivators were perceived benefits of a deepening connection to their clinical team, improved symptom management for themselves and others, and self-reflection about their recovery. Factors limiting motivation included lack of clarity about the purpose of ePROs and a disconnect between symptom items and individual recovery experience. CONCLUSIONS: Patients described being motivated to complete ePROs when reinforced by clinicians and considered ePROs as valuable to their post-discharge experience. Future work should enhance ePRO patient education, improve provider alerts and communications about ePROs, and integrate options to capture patients' complex health journeys.

People who undergo thoracic surgery often experience pain and other symptoms while recovering at home. These symptoms can be severe and may reduce overall quality of life and potentially result in some patients returning to the hospital for future treatment. Electronic Patient-Reported Outcomes can be used as a method for having patients regularly track and report any symptoms they experience while at home, and how severe those symptoms are, using digital technology such as an online survey or automated phone survey. Surgical care team members may then follow up with patients about their symptoms. More information was needed about the patient experience with completing these surveys about their symptoms. In this study, we interviewed patients who had completed Electronic Patient-Reported Outcomes after thoracic surgery to understand what may (or may not) have impelled them to participate and to learn how to improve the use of these surveys for patients. This study found that patients generally felt they were able to complete the symptom surveys. Key motivators included feeling more connected to their surgeon by completing the symptom surveys and having the opportunity to reflect on how their recovery was going at home. However, patients also discussed not having a clear understanding of the purpose of the symptom surveys and how their responses might affect their care. The study findings highlight the need for improved patient education and indicate that improvements to the survey questions and to how surgeons review patients' responses may be needed.

Hardness Distribution of Al2050 Parts Fabricated Using Additive Friction Stir Deposition.

The solid-state additive friction stir deposition (AFSD) process is a layer-by-layer metal 3D-printing technology. In this study, AFSD is used to fabricate Al-Cu-Li 2050 alloy parts. The hardness values for various regions of the as-deposited built parts are measured, and the results are contrasted with those of the feedstock material. The as-fabricated Al2050 parts are found to have a unique hardness distribution due to the location-specific variations in the processing temperature profile. The XRD results indicate the presence of the secondary phases in the deposited parts, and EDS mapping confirms the formation of detectable alloying particles in the as-deposited Al2050 matrix. The AFSD thermal-mechanical process causes the unique hardness distribution and the reduced microhardness level in the AFSD components, in contrast to those of the feedstock material.

Optical image and Vickers hardness dataset for repair of 1080 steel using additive friction stir deposition of Aermet 100.

This article presents optical images, measurements of heat affected zone depths, and peak Vickers hardness values from the heat affected zone regions of a 1080 steel plate substrate with a machined groove "flaw" repaired using additive friction stir deposition of Aermet 100. The deposition of Aermet 100 was performed using a L3 Meld machine with 9.525 mm (0.375 inch) square bar profile Aermet 100 feedstock rods fed through a hollow, 10.16 mm (0.4 inch) diameter, rotating tool onto a 1.02 mm thick 1080 steel plate with a machined groove "flaw" along the plate's length and bisecting the plate's width. The depth of the machined groove "flaw" ranged from 4.7625, 6.35, and 9.525 mm. The data is categorized into four groups: multi-layer builds deposited at room temperature with and without a cooling plate, 2-layer builds deposited at room temperature without a cooling plate, single-layer builds deposited at room temperature without a cooling plate, and a design of experiments for single-layer builds that varied the spindle rotation speed (RPM), travel speed (mm/min), material feed rate (mm/min), and pre-heat temperature (°C) of the deposition. The data shows the parameter conditions that achieved flaw-free consolidated repairs and the associated depth and peak Vickers hardness of the heat affected zone. Optical images of cross-sectioned deposition regions were obtained using an optical microscope with Leco Olympus DP27 macro camera, and Vickers hardness line traces were measured along the depth of the deposited and heat affected zone extending into the substrate on cross-sectioned samples using a Leco LM 247AT microhardness tester. The depth of the heat affected zone is reported as the measured average of five individual data points. Peak values for Vickers hardness for the heat affected zone decreased for pre-heated conditions at 329°C compared to builds conducted at room temperature of 21°C. This dataset provides visual characterization and associated hardness measurements of as-deposited repairs of dissimilar steel alloys. This article can be used to inform parameter selection for additive friction stir deposition of dissimilar steel materials for repair and solid-state additive manufacturing applications.

Effect of Clear vs Standard Covered Masks on Communication With Patients During Surgical Clinic Encounters: A Randomized Clinical Trial.

Importance: During the COVID-19 pandemic, wearing masks has become necessary, especially within health care. However, to our knowledge, the consequences of mask wearing on communication between surgeons and patients have not been studied. Objective: To evaluate the effects of clear vs standard covered masks on communication during surgical clinic encounters. Design: This randomized clinical trial examined communication between surgeons and their patients when surgeons wore clear vs covered masks in surgical outpatient clinics at a single academic medical center. New patients were recruited from participating surgeons' clinic schedules. Interventions: Surgeons wore either clear masks or covered masks for each clinic visit with a new patient, based on a per-visit randomization plan. Main Outcomes and Measures: The primary outcome measures included patient perceptions of (1) surgeon communication and (2) trust in surgeons, as well as (3) quantitative assessments and (4) qualitative assessments regarding patient impressions of the surgeon's mask. After the clinic encounter, patients completed a verbal survey including validated Clinician and Group Consumer Assessment of Healthcare Providers and Systems questions. Additional questions involved surgeon empathy, trust, and the patient's impression of the surgeon's mask. Data were analyzed by comparing patient data in the clear vs covered groups using Cochran-Mantel-Haenszel tests, and comments were analyzed for themes. Results: Two hundred patients were enrolled from 15 surgeons' clinics spanning 7 subspecialties. When surgeons wore a clear mask, patients rated their surgeons higher for providing understandable explanations (clear, 95 of 100 [95%] vs covered, 78 of 100 [78%]; P < .001), demonstrating empathy (clear, 99 [99%] vs covered, 85 [85%]; P < .001), and building trust (clear, 94 [94%] vs covered, 72 [72%]; P < .001). Patients preferred clear masks (clear, 100 [100%] vs covered, 72 [72%]; P < .001), citing improved surgeon communication and appreciation for visualization of the face. Conversely, 8 of 15 surgeons (53%) were unlikely to choose the clear mask over their standard covered mask. Conclusions and Relevance: This randomized clinical trial demonstrates that patients prefer to see their surgeon's face. Surgeons who wore clear masks were perceived by patients to be better communicators, have more empathy, and elicit greater trust. Because masks will remain part of the health care landscape for some time, deliberate attention to preserving communication within the surgeon-patient relationship is warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT04595695.