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The PREFACE Program: Development, Implementation, And Evaluation Of A Multimedia Prehabilitation Program In Facial Feminization Surgery
Anne E. Hall, B.S1, Nghiem H. Nguyen, B.A
2, Catherine T. Cascavita, B.A
1, Justine C. Lee, MD, PhD, FACS
1.
1Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA,
2Kaiser Permanente School of Medicine, Pasadena, CA, USA.
PURPOSE: Prehabilitation interventions have been developed in orthopedic, major abdominal, transplant, and gynecological surgery to improve postoperative outcomes and functional capacity, yet no research exists on prehabilitation for gender-affirming surgery. Given the high rates of mental health comorbidities among transgender and gender-diverse (TGD) individuals, a tailored prehabilitation program for TGD patients undergoing facial feminization surgery (FFS) may further improve their physical and mental health, leading to better outcomes. Previously described prehabilitation interventions prepare patients for surgery by addressing physical fitness, nutrition, mental health, and smoking cessation. This quality improvement project aims to develop, implement, and evaluate an educational multimedia prehabilitation program to improve clinical outcomes after FFS.
METHODS: The program was developed following the American College of Surgeons Quality Improvement Framework. A comprehensive literature review and meta-analysis on psychological, exercise, and nutritional preoperative programs were conducted to inform the development process. The FFS Optimization Model was then established to serve as the foundational framework for guiding both preoperative and postoperative optimization in the prehabilitation program.
A pilot program focusing on comprehensive surgical information, guidance on surgical preparation and recovery, and insights from patient interviews about their experiences with FFS was designed. Semi-structured interviews with patients and clinical staff were conducted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to assess the program’s quality improvement aspects.
RESULTS: A multimedia prehabilitation curriculum aimed at optimizing patient preparedness prior to surgery was developed. The curriculum consists of five pre-recorded video modules accompanied by the program guidebook. The modules include: Surgical Information, Pre-Op Optimization, Post-Op Care, Post-Op Massage for Edema, and Patient Perspectives. Patients scheduled for FFS under a single primary surgeon are eligible to participate in the program 1-3 months before their scheduled surgery date.
A qualitative analysis using the RE-AIM framework was employed to evaluate the program. All patients offered the program chose to participate, motivated by their desire to better prepare for FFS. Additionally, the guidebook was utilized more frequently than the videos (Reach). On a 10-point scale, the program received an average satisfaction rating of 8.0±1.22, with patients highly valuing the detailed surgical information. 100% of patients found the program effective in preparing for surgery and 75% reported it helped reduce preoperative anxiety and stress (Effectiveness). Additionally, 100% of participants noted the program was easy to follow, confirming its feasibility (Adoption). Feedback from patients and clinical staff indicated smooth integration into preoperative care (Implementation). Patients suggested extending the program engagement period to 3-6 months before surgery and incorporating more patient-centered perspectives on short-term post-op recovery, along with a FAQ section (Maintenance).
CONCLUSION: The preliminary findings of our multimedia FFS prehabilitation program demonstrated a positive change in patient satisfaction, acceptability, program effectiveness, and feasibility. Future directions involve obtaining quantitative results to further validate the impact of the program on clinical outcomes such as anxiety, stress, depression, and pain.
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