Validation of a German translation of the CARE questionnaire and its implementation as electronic PROM to assess patient-reported postoperative convalescence and recovery after major urological surgery

Frederik Wessels,Julia Mühlbauer,Manuel Neuberger,Philipp Nuhn,Maurice S Michel,Julian Koenig,Maximilian C Kriegmair,Maximilian Lenhart,Johannes Breyer,Johannes Huber

doi:10.1007/s00345-021-03713-6

Abstract

PurposeTo validate a German translation of the convalescence and recovery evaluation (CARE) as an electronic patient-reported outcome measure (ePROM) and use it to assess recovery after major urological surgery.MethodsThe CARE questionnaire was provided to patients scheduled for major urological surgery preoperatively, at discharge and 6 weeks postoperatively, using an ePROM system. Cronbach’s alpha, inter-scale correlations and confirmatory factor analysis (CFA) were used to validate the translation. Mixed linear regression models were used to identify factors influencing CARE results, and a multivariable logistic regression analysis was done to determine the predictive value of CARE results on quality of life (QoL).ResultsA total of 283 patients undergoing prostatectomy (n = 146, 51%), partial/radical nephrectomy (n = 70, 25%) or cystectomy (n = 67, 24%) responded to the survey. Internal consistency was high (α = 0.649–0.920) and the CFA showed a factor loading > 0.5 in 17/27 items. Significant main effects were found for the time of survey and type of surgery, while a time by type interaction was only found for the gastrointestinal subscale (chi_{(4)}^{2} = 30.37, p < 0.0001) and the total CARE score (TCS) (chi_{(4)}^{2} = 13.47, p = 0.009) for cystectomy patients, meaning a greater score decrease at discharge and lower level of recovery at follow-up. Complications demonstrated a significant negative effect on the TCS (chi_{(2)}^{2} = 8.61, p = 0.014). A high TCS at discharge was an independent predictor of a high QLQ-C30 QoL score at follow-up (OR = 5.26, 95%-CI 1.42–19.37, p = 0.013).ConclusionThis German translation of the CARE can serve as a valid ePROM to measure recovery and predict QoL after major urological surgery.

Highlights

The curative treatment of cancerous urological diseases relies on major surgery, such as radical prostatectomy (RP), radical cystectomy (RC) and partial/radical nephrectomy (R/PN)
Several studies have proven the benefit of postoperative patient care when patientreported outcome measures (PROMs) are routinely used, as their application can lead to better symptom control, an increase in supportive care or a reduction in emergency visits [7, 8]
The application of electronic PROMs has significantly reduced the barriers to PROM use for both patients and physicians alike

Summary

Introduction

The curative treatment of cancerous urological diseases relies on major surgery, such as radical prostatectomy (RP), radical cystectomy (RC) and partial/radical nephrectomy (R/PN). The PROMs are standardized and validated tools or questionnaires [5] to assess patient-reported outcomes, such as postoperative quality of life (QoL), postoperative health status and others [6]. Several studies have investigated general or cancer-specific QoL after major surgery using PROMs [9, 10]. To optimize outpatient care after discharge, detailed and current knowledge of the status of recovery is necessary to reduce complications and readmissions [11]. The convalescence and recovery evaluation (CARE) [12] is a multi-dimensional questionnaire that is available to measure convalescence and health status (HS) after surgery, especially after abdominal and pelvic surgery independent of the underlying condition [13]. Information on the status of recovery at the time of discharge and the further course of recovery is lacking

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