Artificial Intelligence-Supported Individualized Discharge Education After Coronary Artery Bypass Grafting

N/ANot Yet RecruitingNCT07780994

Izmir Katip Celebi University80 enrolled

Overview

This randomized controlled trial aims to evaluate the effect of artificial intelligence-supported individualized discharge education on postoperative recovery in patients undergoing coronary artery bypass grafting. A total of 80 patients will be randomly assigned to an intervention group or a control group. Both groups will receive standard discharge education, while the intervention group will additionally receive individualized discharge education generated with artificial intelligence based on patients' sociodemographic and clinical characteristics, health literacy level, and learning needs. The intervention will be structured according to Gagné's instructional events and will include the teach-back method to assess understanding. Outcomes will include readiness for hospital discharge, postoperative recovery, satisfaction with discharge education, self-care adherence, complications, and unplanned health care use. Assessments will be conducted before discharge, on the day of discharge, and during follow-up after discharge.

Patients undergoing elective isolated coronary artery bypass grafting will be enrolled and allocated to intervention and control groups using stratified randomization based on age, sex, and health literacy level. Randomization within each stratum will be performed using Randomizer.org. Patients in the control group will receive the routine standard discharge education used in the cardiovascular surgery clinic. This education will include wound care, medication use, nutrition, physical activity, follow-up appointments, and warning signs after discharge. Patients in the intervention group will receive the same standard education plus artificial intelligence-supported individualized discharge education. Individualized educational content will be prepared using standardized prompts adapted to each patient's age, sex, education level, health literacy, comorbidities, and surgical characteristics. The educational process will be structured according to Gagné's instructional events, including gaining attention, recalling prior knowledge, providing guidance, eliciting performance, and providing feedback. Teach-back questions will also be individualized to evaluate patient understanding and identify learning needs. Baseline assessments will be performed 24-48 hours before discharge. Post-intervention assessments will be completed on the day of discharge. Follow-up assessments will be conducted on postoperative day 10 and at 1 month after discharge through clinic visits, telephone interviews, and patient records. Clinical outcomes will include postoperative recovery, readiness for discharge, discharge education satisfaction, self-care and medication adherence, complications, emergency department visits, and hospital readmissions. Personally identifiable patient information will not be entered into the artificial intelligence system. All artificial intelligence-generated educational content will be reviewed by the research nurse and the relevant physician for clinical accuracy, safety, comprehensibility, and appropriateness before being delivered to patients.

Interventions

Artificial Intelligence-Supported Individualized Discharge EducationBEHAVIORAL

Participants will receive individualized discharge education supported by artificial intelligence in addition to routine standard discharge education. The content will be tailored to individual characteristics, health literacy, comorbidities, surgical characteristics, and learning needs. The education will be structured according to Gagné's instructional events and will include the teach-back method.

Standard Discharge EducationBEHAVIORAL

Routine discharge education provided in the cardiovascular surgery clinic, including wound care, medication use, nutrition, physical activity, follow-up appointments, and warning signs after discharge.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18 years or older. * Having undergone elective isolated coronary artery bypass grafting. * Ability to communicate in Turkish. * No cognitive or communication impairment that would prevent participation in the study. * Voluntary agreement to participate in the study and provision of written informed consent. Exclusion Criteria: * Refusal to participate in the study or failure to provide written informed consent. * Age under 18 years. * Inability to communicate in Turkish. * Cognitive impairment, delirium, dementia, or a severe psychiatric condition preventing completion of the data collection tools. * Having undergone emergency surgery. * Presence of a severe postoperative complication preventing delivery of the planned discharge education. * Inability to be reached during the follow-up period. * Incomplete completion of the data collection forms. * Withdrawal from the study at any stage.

Outcomes

Primary Outcomes

Postoperative Recovery Assessed Using the Post-Discharge Surgical Recovery Scale

Postoperative recovery will be assessed using the Post-Discharge Surgical Recovery Scale. The scale consists of 15 items, each scored from 1 to 10. The raw total score ranges from 15 to 150. Higher scores indicate better postoperative recovery. The scale evaluates postoperative recovery across areas including pain, mobility, self-care ability, activity level, and return to daily life.

Time frame: 10 days and 1 month after discharge

Unplanned Health Care Utilization Assessed by Emergency Department Visits and Hospital Readmissions

Unplanned health care utilization will be assessed based on emergency department visits and hospital readmissions occurring during the 30-day period after discharge. Information will be obtained through patient follow-up and, when available, verified using hospital records.

Time frame: Within 30 days after discharge

Secondary Outcomes

Change in Readiness for Hospital Discharge Assessed Using the Readiness for Hospital Discharge Scale-Short Form

Readiness for hospital discharge will be assessed using the Readiness for Hospital Discharge Scale-Short Form. The scale consists of 8 items, each scored from 0 to 10. Higher scores indicate greater readiness for hospital discharge. The scale assesses physical readiness, energy, knowledge regarding post-discharge care, ability to manage daily and personal care needs, and expected support after discharge. The scale will be administered at baseline and again on the day of hospital discharge to evaluate change in readiness for discharge.

Time frame: Baseline (24-48 hours before hospital discharge) and within 1-3 days after the intervention

Satisfaction With Discharge Education Assessed Using the Discharge Education Satisfaction Scale for Surgical Patients

Satisfaction with discharge education will be assessed using the Discharge Education Satisfaction Scale for Surgical Patients. The scale consists of 21 items rated on a 5-point Likert scale. Total scores range from 21 to 105, with higher scores indicating greater satisfaction with the discharge education received. The scale assesses patients' satisfaction with the adequacy, clarity, and content of discharge education.

Time frame: Within 1-3 days after the intervention

Postoperative Complications Assessed Through Patient Follow-up and Medical Records

Postoperative complications will be assessed through patient follow-up and medical records. Complications of interest will include surgical site infection, arrhythmia, and respiratory complications. When available, complication data will be verified using hospital records.