title: Patient Empowerment Improved Perioperative Quality of Care in Cancer Patients Aged ≥ 65 Years - A Randomized Controlled Trial.
abstract: OBJECTIVE
  This randomized controlled, clinical prospective interventional trial was aimed at exploring the effect of patient empowerment on short- and long-term outcomes after major oncologic surgery in elderly cancer patients.
  
  
  METHODS
  This trial was performed from February 2011 to January 2014 at two tertiary medical centers in Germany. The study included patients aged 65 years and older undergoing elective surgery for gastro-intestinal, genitourinary, and thoracic cancer. The patients were randomly assigned to the intervention group, i.e. patient empowerment through information booklet and diary keeping, or to the control group, which received standard care. Randomization was done by block randomization in blocks of four in order of enrollment. The primary outcome were 1,postoperative length of hospital stay (LOS) and 2. long-term global health-related quality of life (HRQoL) one year postoperatively. HRQoL was assessed using the EORTC QLQ C30 questionnaire. Secondary outcomes encompassed postoperative stress and complications. Further objectives were the identification of predictors of LOS, and HRQoL at 12 months.
  
  
  RESULTS
  Overall 652 patients were included. The mean age was 72 ± 4.9 years, and the majority of patients were male (68.6%, n = 447). The ^median of postoperative length of stay was 9 days (IQR 7-14 day). There were no significant differences between the intervention and the control groups in postoperative LOS (p = 0.99) or global HRQoL after one year (women: p = 0.54, men: p = 0.94). While overall complications and major complications occurred in 74% and 24% of the cases, respectively, frequency and severity of complications did not differ significantly between the groups. Patients in the intervention group reported significantly less postoperative pain (p = 0.03) than the control group. Independent predictors for LOS were identified as severity of surgery, length of anesthesia, major postoperative complications, nutritional state, and pre-operative physical functional capacity measured by the Timed Up and Go-test by multiple robust regressions.
  
  
  CONCLUSIONS
  Patient empowerment through information booklet and diary keeping did not shorten the postoperative LOS in elderly onco-surgical patients, but improved quality of care regarding postoperative pain. Postoperative length of stay is influenced by pre-operative nutritional state, pre-operative functional impairment, severity of surgery, and length of anesthesia.
  
  
  BACKGROUND
  Clinicaltrials.gov. Identifier NCT01278537.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Charité Research Group on Geriatrics, Charité- Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Rahel
authors.initials: R
authors.lastname: Eckardt
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Scholtz
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Neuner
authors.affiliation: Department of Anesthesiology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: von Dossow-Hanfstingl
authors.affiliation: Department of Gynecology, European Competence Center of Ovarian Cancer, Charité Campus Virchow-Klinikum, Charité- Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.affiliation: Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Charité-Universitätsmedizin Berlin and SoStAna GmbH, Berlin, Germany.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
mesh_terms: D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D005858:Germany; D006801:Humans; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D013899:Thoracic Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D014565:Urogenital Neoplasms / Q000601:surgery