# Applying User-centered Design and Implementation Science to Enhance Prehabilitation for Frail Older Adults Undergoing Lung Cancer Surgery

> **NIH NIH R03** · UNIVERSITY OF CHICAGO · 2024 · $164,000

## Abstract

Project Abstract
Lung cancer is the leading cause of cancer-related death in the United States. Up to 30% of patients may be
eligible for surgical resection for treatment. Currently, however, more than half of patients undergoing lung
cancer resection are older adults (≥65 years) and 70% of thoracic surgery patients are “pre-frail” or
“frail.” Frailty portends poor perioperative outcomes, such as increased postoperative complications,
length of stay, hospital costs, post-discharge institutionalization and mortality. The American College of
Surgeons and other international societies recommend frailty mitigation by offering patients prehabilitation
(prehab) programs that focus on exercise, nutrition, and social support. Yet, despite evidence of efficacy in
clinical trials, only 10-30% of patients actually adhere to prehab programs and the translation of these
programs into clinical practice has been challenging. In our pilot study of BeFitMe™, a prehab smartphone
application that provides, encourages, and tracks self-guided at-home exercise, based on the National
Institute of Aging Go4Life exercise videos, only 14% of patients downloaded the app. However, those who did
download the app averaged 38 ± 8.8 minutes of daily exercise, 1,862 ± 2000 steps per day, and 11.9 ±4.3
days of prehab activity; non-users were more likely to be older, male, and Black. Lack of robust “end-user”
input into intervention design, particularly behavioral interventions, can lead to poor acceptability and
adherence. Indeed, we are unaware of any current prehab program that applied a user-centered design
approach to fully ascertain and address the specific needs, values, and preferences of the end-users,
particularly older adults. Furthermore, no programs report using implementation science principles to introduce
and adapt the intervention to varied clinical contexts. As a Stage I study in the NIH Stage Model for Behavioral
Intervention Development, we propose to (1) Gather end-user (patients, caregivers, clinicians) perspectives
and engage them as co-designers to redesign and enhance BeFitMe™ to increase its use and participation
among older adults undergoing lung cancer surgery and (2) Use an implementation framework to increase
reach, adoption, and sustainability of the prehab program. To achieve my immediate goal of enhancing the
existing prehab app to optimize its use by prefrail/frail older adult lung cancer patients who will undergo
resection, I have convened a team of experts in user-centered design, implementation science, qualitative
research, prehab, geriatric oncology, lung cancer, and thoracic surgery. My long-term goal is to become an
independent investigator focused on optimizing the pre-hospital, in-hospital, and post-hospital phases of
surgical care for prefrail/frail older adults with lung cancer.

## Key facts

- **NIH application ID:** 10912030
- **Project number:** 5R03AG082987-02
- **Recipient organization:** UNIVERSITY OF CHICAGO
- **Principal Investigator:** Maria Lucia Madariaga
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $164,000
- **Award type:** 5
- **Project period:** 2023-09-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10912030

## Citation

> US National Institutes of Health, RePORTER application 10912030, Applying User-centered Design and Implementation Science to Enhance Prehabilitation for Frail Older Adults Undergoing Lung Cancer Surgery (5R03AG082987-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10912030. Licensed CC0.

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