MULTIDISCIPLINARY RECOMMENDATIONS AND PATIENT WEBLOG FOR RESUMPTION OF WORK ACTIVITIES AFTER GYNAECOLOGICAL SURGERY. A modified Delphi study, focus group discussions and pilot study.

B A C K G R O U N D Resumption of work activities after various gynaecological surgical procedures takes much longer than expected, irrespective surgical technique and level of invasiveness.[1,2,3] There is strong evidence that long periods out of work not only result in a high risk on work disability, but also can cause or contribute to 2-3 times increased risk of poor general health, 2-3 times increased risk of mental health problems and even 20% excess mortality.[4,5] However recommendations for post-operative resumption of work activities are mostly not provided by medical specialists due to a lack of knowledge about the physical demands of the job. In addition, communication between doctors in the peri-operative period is poor and often conflicting advises are given.[7,8] The Dutch Health Council [HC] stated that there is a strong need for multidisciplinary recommendations for resumption of (postoperative) work activities.[6] However little is known about patients’ needs, (illness) beliefs and preferences regarding postoperative care and resumption of work activities.[15,22] O B J E C T I V E S OBJECTIVE 1 (literature review and modified Delphi study) Development of evidence and consensus based multidisciplinary recommendations for postoperative (graded) resumption of work activities and exercises: 1) To improve the (cost)effectiveness of postoperative medical care on work resumption and quality of life 2) To improve the quality of postoperative transmural care (by consensus about postoperative advises). OBJECTIVE 2 (focus groups & pilot study) Development of a patient weblog for postoperative (graded) resumption of work activities: 1) To identify patients needs, preferences, attitudes and beliefs regarding postoperative care and resumption of work activities 2) To improve patient satisfaction and adherence with postoperative recommendations 3) To identify patients at risk for delayed resumption of (work) activities and work disability OBJECTIVE 3 (KTE) Knowledge transfer and implementation of the multidisciplinary recommendations and weblog by presentations, publications, guideline development, patient information, and websites by all involved stakeholders (medical boards, patient organisations, researchers). M E T H O D S In this project doctors and patients will collaborate to develop multidisciplinary recommendations, case descriptions and a patient weblog to support postoperative (graded) resumption of (un)paid work activities and to improve (online) patient-doctor communication after gynaecological surgery. The project will use an innovative efficient stepwise approach. The study design is based on a method developed (by the principal applicant) in a project commissioned by Health Care Insurance Board (CVZ), the board of medical specialists (OMS) and the board of occupational physicians (NVAB). According to the Quality Institute for Health Care (CBO) and the HC it has shown to be a useful method to bridge gaps in existing evidence resulting in postoperative recommendations the CBO-guideline for Capal Tunnel Syndrome(CTS).[6,20] The project combines both quantitative and qualitative methods to develop evidence and consensus-based multidisciplinary recommendations and a patient weblog: 1) LITERATURE STUDY A systematic literature search in (inter)national databases regarding postoperative resumption of work activities after various surgical procedures of uterus and/or adnex. 2) MODIFIED DELPHI STUDY Recommendations for (graded) resumption of postoperative work activities will be developed by an multidisciplinary expert panel (consisting of all relevant medical disciplins) in several rounds. 3) FOCUS GROUPS AND DEVELOPMENT OF THE PATIENT WEBLOG Development of the weblog with recommendations based on the results of focus group discussions with patients and the Delphi study. 4) PILOT STUDY - Pilot study and process evaluation to test the patient weblog and recommendations. - If necessary, the weblog will be adapted based on results of the pilot study 5) KNOWLEDGE TRANSFER AND IMPLEMENTATION - publication & presentation of study results E X P E C T E D R E S U L T S 1) A light version of a multidisciplinary guideline: Evidence- and consensus-based multidisciplinary recommendations for (graded) resumption of work activities after various surgical procedures of adnex and/or uterus on benign indications. 2) Patient weblog addressing patients needs to support and to inform patients and primary care physicians regarding resumption of work activities and to provide an opportunity for online communications with the attending gynaecologist or primary care physician. P L A N N I N G 1) Month 1 Literature study 2) Month 2-8 Modified Delphi study 3) Month 2-9 Focus groups and development of the patient weblog 4) Month 10-18 Pilot study & process evaluation 5) Month >18 Knowledge transfer and implementation of the recommendations and weblog