Knowledge Translation and Patient Co-production in the field of General Surgery: A decade review and analogy with the Game Theory

The healthcare system is currently undergoing a phase of transformation and evolution, gradually shifting from a physician-centred to a patient-centred approach. In order for such an aim to be achieved, the essential prerequisite is to obtain the engagement of the patient. In turn, patient engagement is linked to two fundamental concepts: knowledge translation (KT) and patient co-production. The former ensures a correct delivery of information and education; the latter describes the process of activation of the patient, who becomes an actual contributor to his own therapeutic path, both in terms of decision making and participation in treatment steps, via the use of tools whose nature ranges from interviews to mobile phone apps and smart trackers of vital parameters. The world of surgery is displaying an increasing interest in patient engagement, for it allows to improve the surgical outcome and reduce the rate of complications, both in the short- and long-term. The aim of this dissertation is to analyse the role of KT and patient co-production in the field of General surgery, selecting published studies which had to display the following characteristics: (i) involving patients (and/or their relatives) undergoing abdominal, bariatric or breast surgeries; (ii) describing the results of the use of co-production tools, thereby ensuring an active engagement of the patients (and/or their relatives); (iii) being published between 2010 and 2020. Overall, 67 articles were found to be fulfilling such criteria. The research has pointed out that studies concerning abdominal surgeries are actually representing 41.8% of the selected literature, with breast and bariatric surgeries accounting for 41.8% and 16.4% respectively. This result could be explained by the impacting epidemiological burden of breast cancer, and the well-known need for patient adherence and commitment in order for bariatric surgery to ensure long-lasting results. As far as the articles referring to abdominal surgeries are concerned, the analysed literature has shown an increasing interest in patient engagement, especially in the peri-operative phase. In fact, the 50% of the studies were focused on this specific moment of the surgical path. Moreover, there is a progressive digitalisation of the tools utilised for co-production achievement. In particular, the year 2016 has consistently represented a turning point, in terms of (i) research dedicated to the matter; (ii) focus directed towards the activation of the patient in the peri-operative phase; and (iii) use of technology-based tools. Concerning the latter, it is possible to foresee a future in which telehealth and telemedicine will play an important - if not maximal - role, especially in view of the ongoing Sars-CoV-2 pandemic, which is imposing social distancing. An interesting approach to KT and co-production is that which compares the patient-physician relationship to a cooperative non-zero-sum game, as per the Game Theory, the latter having John von Neumann, Oskar Morgenstern and John Forbes Nash Jr as its major contributors. In fact, even such an intrinsically-human interaction can be described as a mathematical and predictable model, allowing to further strengthen the fundamental role of KT and co-production in increasing the magnitude of the eventual result and minimising the chances of adverse outcomes.