Patient-Reported Discharge Readiness After Cancer Surgery: A Multidimensional and Temporally Evolving Process.

Abstract

Safe and effective discharge after cancer surgery requires accurate assessment of patient readiness; however, current approaches largely rely on provider-defined criteria and may not capture the patient experience of readiness for home. The objective of this study was to identify key components of discharge readiness and examine their temporal relationships following cancer surgery. We conducted a concurrent nested mixed-methods study at a single National Cancer Institute-designated comprehensive cancer center of patients undergoing colorectal, thoracic, or gynecologic cancer surgery, all of whom had access to the Goals to Discharge electronic patient-reported outcome (ePRO) tool through an institutional pilot program. Qualitative interviews with a subgroup of patients were used to develop a conceptual framework of discharge readiness and classify milestones from the ePRO tool into physiologic, psychosocial, and operational domains. Longitudinal milestone responses were then analyzed to compare domain-specific recovery trajectories. Qualitative interviews identified three domains of discharge readiness: physiologic, psychosocial, and operational. Quantitative analysis included 2,828 milestone assessments. Completion increased across all domains during hospitalization but progressed asynchronously. Physiologic and psychosocial milestones tracked closely, reaching 88% completion in the 6 hours before discharge, whereas operational milestones lagged, reaching 58%. These differences persisted after multivariable adjustment. From the patient perspective, discharge readiness after cancer surgery is a multidimensional and temporally evolving process. Operational readiness lags physiologic and psychosocial recovery, suggesting modifiable system-level barriers. Patient-reported, domain-specific assessments may improve the safety and efficiency of surgical discharge.