Presentation Authors: Tudor Borza*, Madison , WI, Daniela A Wittmann, Kevin Zhu, Benjamin Li, Ann Arbor, MI, Ken Urish, Pittsuburg, PA, Jonathan E Helm, Bloomington, IN, Mariel Lavieri, Ann Arbor, MI, Bruce L Jacobs, Pittsuburg, PA, Ted A Skolarus, Ann Arbor, MI
Introduction: Readmission following radical cystectomy is common with rates remaining around 30% for over 15 years. Efforts relying on clinical and administrative data have failed to identify predictors or targetable factors to reduce readmissions. For these reasons, we conducted a qualitative study to explore patient and caregiver perspectives regarding readmission with the aim of identifying novel targets for readmission reduction efforts.
Methods: We identified patients readmitted within 30 days of discharge following radical cystectomy. We performed semi-structured interviews with patients and, when possible, caregivers intended to elicit their perspectives on factors contributing to readmission. Interviews were recorded and transcribed verbatim. Using a Grounded Theory approach, transcripts were coded to identify overarching themes by 2 independent reviewers. Coding was performed iteratively and interviews updated. Study accrual was stopped once thematic saturation was achieved.
Results: We performed 13 interviews: 6 with patient-caregiver pairs and 7 patients only. Five themes that highlight the patient experience regarding readmission emerged: (i) patients uniformly felt ready for discharge; (ii) patients rely on caregivers to perform routine activities as they face complex physical and emotional challenges in the immediate postoperative period; short ( < 24h) delays in care arise from (iii) patient (confusion regarding postoperative expectations, minimizing and efforts to self-manage complications) and (iv) systems issues (difficulty navigating medical system); (v) caregivers frequently regard complications and seeking care more urgently than patients.
Conclusions: This is the first study to explore patient and caregiver perspective on readmission following radical cystectomy and provides possible targets for intervention in the immediate postoperative period. These readmissions do not appear preventable or secondary to early discharge or other system access factors. Uncertainty in differentiating between expected postoperative course and complications leads to delays in presentation and may be alleviated with improved education in the pre- and perioperative setting. Patients without close caregivers are at risk for delays in presentation and may benefit from increased clinical contact (visiting nurse assistance, clinic phone calls, etc).
Source of Funding: University of Michigan Rogel Cancer Center Endowment for Discovery Fund Grant G020079 (TB, DAW, TAS)