Patient-facing e-health interventions to promote self-management in adult surgical patients: A scoping review

Objective
This scoping review aimed to identify and synthesise existing literature on patient-facing e-health interventions to support self-management and preparation for or recovery from surgery for adult patients.

Introduction
Patients waiting for surgery often experience distress and uncertainty, which can lead to suboptimal surgical preparation and recovery. E-health interventions may provide new models of care to address these issues and maximise value-based healthcare.

Inclusion criteria
Studies were included if adult patients utilised an e-health intervention to support self-management in preparation for and recovery from their surgery, with interventions targeting any perioperative phase.

Methods
The review followed Joanna Briggs Institute methodology and included sources from 2010 onwards in MEDLINE, Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, Google Scholar and ProQuest. Four reviewers undertook screening and data was presented in tabular and diagrammatic form with a narrative summary.

Results
From 2293 records, 48 papers with a total of 41 unique studies from 15 countries were included. Most interventions supported patients in the postoperative phase only for bowel/colorectal cancer surgery and total hip arthroplasty Quality was generally good to average, with limitations including small sample sizes, single-centre studies, and a failure to include a comparison group. Just 35 % of interventions were codesigned with input from patients during the development process. Development and evaluation methods were workshops (17 %) and unvalidated attitudinal studies (65 %), respectively. E-health interventions showed positive impacts on clinical outcomes (54 %), user satisfaction (65 %), utilisation of the interventions (46 %), and health system outcomes (24 %).

Conclusions
E-health interventions for self-management of surgery preparation and recovery were prevalent in 15 countries, but mostly focused on postoperative support and lacked input from end-users during development. Future studies should address these limitations by creating applications that support patients from all surgical specialities and involving patients and families in the development process.