L. Mark Knab, MD

Dr. Knab: There is a gap in knowledge of gastrointestinal cancers and ovarian cancers and in understanding the preparedness of those who are undergoing some of the bigger and more complex operations.  

There exists comparable research done on conditions like breast cancer. We wanted to examine how social determinants of health may impact the patient’s perioperative state in the hospital and their postoperative course. My hypothesis was that this might be magnified with people going home with tube feeds, surgical drains, or several follow-up appointments. These may be people who may have trouble going to the hospital and risk being readmitted because they cannot get back to the clinic for checkups.

We developed and disseminated a quality of life survey and a depression questionnaire that is widely used preoperatively and then again at one-month, three-month, and sixmonths intervals postoperatively. In addition, we collected several social determinants of health variables including housing, food, income, job security, and social support. Our goal is to get to about 250 patients.

Can the quality of life surveys be administered by a nurse or is it an assessment that the patient can do entirely on their own? The patient can do it entirely on their own. We bounced several ideas around. But ultimately, we decided that the patient could just fill it out. It’s not cumbersome and it’s not complicated.

Can the quality of life surveys be administered by a nurse or is it an assessment that the patient can do entirely on their own?
The patient can do it entirely on their own. We bounced several ideas around. But ultimately, we decided that the patient could just fill it out. It’s not cumbersome and it’s not complicated.

In your proposal, you mentioned sometimes English language comprehension can be a barrier for people. Thinking about Maywood and the demographics that you serve, there is a large Spanish-speaking population. Is there a Spanish language element to the survey?
Yes, we had it translated into both Spanish and Polish. We have those three languages available.

Do you think that some of your findings may affect clinical decision support or change patient engagement in some capacity that could lead to improved outcomes?
Ultimately, I would love to see if we can identify a couple key factors. For example, “I don’t have enough money for food before my big GI cancer surgery” or “I don’t have the social support to help take care of these home needs” represent identified needs. The goal is to identify some high yield issues and preemptively address them. If I see a 75-year old Hispanic woman with a specific risk profile, I want to know what I can do pre-op before her surgery and then in the postoperative period to reduce her risk of getting into trouble. Maybe it is nutritional support before surgery or arranging special home care. Ultimately, the goal would be to identify some of these things that we could address and preemptively intervene on to avoid readmissions and complications.