Optimization of care and recovery in older colorectal cancer surgery patients: a hybrid effectiveness-implementation...

The exponential rise in colorectal cancer surgeries among older adults combined with 30-day readmission rates as high as 25% highlights the crucial need to optimize post-discharge care. While geriatrics surgery programs such as the Optimization of Senior Care and Recovery (OSCAR) model improve outcomes, they do not address the post-discharge transition. This study will address this gap by systematically integrating the OSCAR program with an evidence-based Care Transitions Intervention (CTI), using implementation science frameworks to guide adaptation. The resulting integrated model, OSCAR-S, will be evaluated in a pilot feasibility hybrid type 1 implementation-effectiveness trial.

This three-phase project will apply implementation science frameworks to adapt and test an integrated care transition model (OSCAR-S) for older colorectal surgery patients. The first phase involves qualitative interviews with stakeholders to inform the adaptation of the combined model (OSCAR-S), guided by the ADAPT, Consolidated Framework for Implementation Research (CFIR), and FRAME frameworks. Subsequently, we will determine an optimal implementation strategy, guided by the Expert Recommendations for Implementing Change (ERIC). The final phase will include a pilot feasibility type I implementation-effectiveness trial. Guided by the RE-AIM framework and through a mixed methods approach, we will collect quantitative data from electronic medical records and qualitative data from post-implementation interviews to evaluate reach, effectiveness, adoption, implementation, and maintenance.

This study will offer insights into the adaptation, implementation, and assessment of an integrated care transition model (OSCAR-S) for older adults undergoing major colorectal surgery. The model integrates core components of two evidence-based interventions: OSCAR (geriatrics surgery co-management) and CTI (Care Transitions Intervention) programs. A novel aspect of this work is the application of multiple implementation science frameworks to guide this process. The findings will inform future strategies to optimize care transitions and postoperative outcomes, demonstrating how the implementation science approach can enhance the effectiveness and scalability of integrated care models.

This trial was registered at ClinicalTrials.gov ( NCT06752031 ). Registered December 30, 2024.