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Surgery school

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Overview

Delivery of group based prehabilitation education, often known as ‘Surgery school’ or ‘Cancer school’ is increasingly being integrated within routine care internationally.1,2

The aim of Surgery school is to:

  • Improve patients’ understanding of surgery
  • Provide advice to improve their preparation and recovery
  • Empower them to be involved in their preparation and recovery3.

There is increasing evidence regarding the benefits of surgery school, with a recent systematic review and meta-analysis finding surgery school alone resulted in a small reduction in hospital length of stay and decreased chances of post-operative complications4.

Patients also reported increased motivation, knowledge and reduced anxiety in preparation for surgery. However, many of the included papers were in orthopaedic populations, and therefore further research is needed including randomised trials in major surgical specialties4.

 

What is included

In some centres universal interventions delivered in person, or via webinars or pre-recorded videos is termed ‘Surgery school’.

Surgery school generally consists of education on:

  • Prevention of post-operative pulmonary complications
  • Physical activity
  • Respiratory education
  • Nutrition
  • Pain management
  • Psychological support
  • If relevant, the enhanced recovery after surgery (ERAS) program5.

Surgery school was traditionally presented as a face-to-face session but has proven to be feasible when presented as an online service5.

The are many benefits of online surgery school, or virtual surgery school, including allowing rural patients to attend and minimising time spent travelling5.

Surgery school example

At an existing hospital, virtual surgery school was delivered on the zoom platform and offered bimonthly as a 1-hour session5.

Figure 1 Overview of the Webinar Delivery process5.

Virtual surgery school content5

Factors to consider when planning surgery school are discussed below.

It is recommended the pre-recorded education sessions cover the prehabilitation topics below.

These can presented by a live facilitator who was also available to answer questions and trouble shoot any technical difficulties5. Surgery school can be presented using other methods such as a module in the Learning Management System for patients or via Digital Health Platforms.

Examples of a hospital prehabilitation surgery school videos can be found below. These are intended to be used as an example for services to be able to generate their own setting-appropriate material.

Additional information and videos related to each section of surgery school can also be found here: Visit Surgery school website

1. Welcome and evidence for the session
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2. Respiratory care bundle (aCOUGH)
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3. Exercise prehabilitation
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4. Nutrition before and after surgery
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5. Pain management after surgery
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6. Psychological preparedness and relaxation
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Considerations when planning surgery school

Consideration is needed in designing the format and mode of delivery of universal interventions, based on the specific needs of the target group, to enable it to have the greatest reach and benefit. Aspects to consider include:

  • Socioeconomic status – such as providing free vs cost-for-service
  • Health literacy
  • Access to hard copy materials in addition to access to electronic devices for online written information, videos or virtual group attendance
  • Learning styles of patients
  • Cultural and linguistically diverse populations – translation required for written information/videos.
References
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Surgery school overview Surgery school example Considerations when planning surgery school
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Acknowledgements

Co-Principal Investigators:

  • A/Prof Alicia Martin – Director of Allied Health, Peter MacCallum Cancer Centre
  • Jenelle Loeliger – Manager Nutrition and Speech Pathology, Peter MacCallum Cancer Centre

Project Manager: ​

  • Dr Christina Prickett​ – Clinical Psychologist, Peter MacCallum Cancer Centre

Project team:​

  • Dr Rajib Ahmed​ – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Professor Linda Denehy​ – Head of Allied Health Research, Peter MacCallum Cancer Centre
  • Ben de Zoete – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre
  • Dr Lara Edbrooke – Allied Health Research Development Lead, Peter MacCallum Cancer Centre
  • Dr Maria Ftanou – Director of Psychosocial Oncology, Peter MacCallum Cancer Centre
  • A/Prof Hilmy Ismail – Anaesthetist, Peter MacCallum Cancer Centre
  • Professor Berhard Riedel​ – Director of Anaesthetics, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre
  • Catherine Sinton​ – Clinical Nurse Consultant, Peter MacCallum Cancer Centre
  • Anya Trail​l – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre

Communications Advisor:

  • Maddison Gray – Communications & Media Specialist, Western & Central Melbourne Integrated Cancer Services (WCMICS)

Clinical content leads: ​

  • Dr Raj Ahmed – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Anna Beaumont – Dietitian, Peter MacCallum Cancer Centre
  • Jess Crowe – Physiotherapist, Peter MacCallum Cancer Centre
  • Dr Fiona Lynch – Clinical Psychologist, Peter MacCallum Cancer Centre
  • Lisa Nguyen – Physiotherapist, Peter MacCallum Cancer Centre
  • Catherine Sinton – Clinical Nurse Consultant, Peter MacCallum Cancer Centre

Steering committee members:

  • Dr Rajib Ahmed​ – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Michael Barton – Deputy Manager, Western & Central Melbourne Integrated Cancer Services (WCMICS)
  • Hollie Bevans – Senior Dietitian, Western Health
  • Professor Linda Denehy​ – Head of Allied Health Research, Peter MacCallum Cancer Centre
  • Janelle Devereux and Bianca Bell – Executive Director, Health Systems Integration, North West Melbourne Primary Health Network (NWMPHN)
  • Ben de Zoete – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre
  • Dr Lara Edbrooke – Allied Health Research Development Lead, Peter MacCallum Cancer Centre
  • Dr Maria Ftanou​ – Director of Psychosocial Oncology, Peter MacCallum Cancer Centre
  • Mr Michael Hii – Deputy Director, HPB and Upper GI Surgery, St Vincent’s Hospital Melbourne
  • A/Prof Hilmy Ismail​ – Anaesthetist, Peter MacCallum Cancer Centre
  • Drew Kenneady – Consumer Representative
  • Mainak Majumdar – Director, Critical Care, Mercy Health
  • A/Prof Alicia Martin ​- Director of Allied Health, Peter MacCallum Cancer Centre
  • Sharyn McGowan – Allied Health Team Leader, Bendigo Health
  • Fiona McKinnon – Director of Allied Health, St Vincent’s Hospital Melbourne
  • Orla McNally – Surgeon, The Royal Women’s Hospital
  • Jenelle Loeliger – Manager Nutrition and Speech Pathology, Peter MacCallum Cancer Centre
  • Denise Mitchell – Consumer Representative
  • Kathryn Pierce – Western Health Allied Health Representative, Western Health
  • Amanda Piper – Head of Cancer Strategy, Cancer Council Victoria (CCV)
  • Dr Christina Prickett​ – Clinical Psychologist, Peter MacCallum Cancer Centre
  • Professor Berhard Riedel​ – Director of Anaesthetics, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre
  • Catherine Sinton​ – Clinical Nurse Consultant, Peter MacCallum Cancer Centre
  • Anya Trail​l – Manager Physiotherapy & Occupational Therapy, Peter MacCallum Cancer Centre
  • Chris White – Director, Cancer Centre, Bendigo Health

Contributions to content:

  • Shaza Abo – Physiotherapist, Peter MacCallum Cancer Centre
  • Dr Diva Baggio – Haematology Laboratory Registrar, Peter MacCallum Cancer Centre
  • A/Prof Cherie Chiang – Endocrinologist & Internal Medicine Consultant Physician, Peter MacCallum Cancer Centre
  • Professor Linda Denehy​ – Head of Allied Health Research, Peter MacCallum Cancer Centre
  • Dr. Amy Dennett – Physiotherapist, La Trobe University
  • A/Prof Helena Frawley – Principal Research Fellow, Allied Health, University of Melbourne
  • Dr Margaret He – Consultant Anaesthetist, Tauranga Hospital, New Zealand
  • Dr Nicolette Holt – Respiratory, Sleep & Perioperative Consultant Physician, Peter MacCallum Cancer Centre
  • A/Prof Hilmy Ismail​ – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Ms Alana Jones – Enhanced Recovery after Surgery Nurse Coordinator, Royal Melbourne Hospital
  • Erin Laing – Dietitian, Peter MacCallum Cancer Centre
  • Dr Debra Leung – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Tennille Lewin – Centre for Health Services Research, Peter MacCallum Cancer Centre
  • Celia Marsten – Occupational Therapist, Peter MacCallum Cancer Centre
  • Dr Walston Martis – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Dr Mark Nolan – Consultant Cardiologist, Peter MacCallum Cancer Centre
  • Dr Chad Oughton – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • Ella Sexton – Clinical Psychologist, Peter MacCallum Cancer Centre
  • Dr Emma Tyson – Consultant Anaesthetist, Peter MacCallum Cancer Centre
  • A/Prof David Westerman – Consultant Haematologist, Peter MacCallum Cancer Centre
  • A/Prof Jamie Young – Pain & Rehabilitation Consultant Physician, Peter MacCallum Cancer Centre

The project team sincerely thanks all participants from various stages of this project:

  • The consumers, health professionals and other experts who participated in the co-design workshops
  • The health professionals and patients from the three implementation sites including Western Health, Bendigo Health and St Vincents Hospital Melbourne.


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