Aims: Enhanced Recovery After Surgery (ERAS) guidelines include patient-led behaviours to optimise recovery from surgery (Early Drinking, Eating and Mobilisation; ‘DrEaMing’). However, despite established benefits, adherence is often suboptimal. This RCT evaluates the preliminary efficacy of ‘RecoverEsupport Breast’, a co-designed digital health intervention to support women undergoing breast cancer surgery to adhere to patient-led recommended ERAS behaviours.
Methods: A two-arm pilot RCT was undertaken at an Australian public cancer centre. Women undergoing mastectomy were randomised to usual care or usual care plus ‘RecoverEsupport Breast.’ The digital intervention incorporated evidence-based behaviour change techniques delivered through a website incorporating text-based information, clinician videos, reminders (SMS/email), daily checklists, and tailored feedback. Data was collected from medical records and patient online surveys (baseline, 30- and 90-days post-surgery). Outcomes included 1) Adherence to ERAS recommendations (Early Drinking, Eating and Mobilisation) 2) PROMS (Quality of Recovery [QoR-15], Quality of Life [QLQ-C30], Anxiety [HADS-A], and 3) Health service outcomes (length of hospital stay, readmissions, ED presentations, healthcare use post-discharge). Bayesian analyses estimated the probability of intervention superiority.
Results: Between July 2024 and October 2025, 46 patients were approached and 23 consented (Target n=70) and were randomised. Compared with usual care, intervention participants; mobilised more on Day 1 post-surgery (MD=247 minutes; Pr(superiority)=97%); had higher Quality of Recovery (MD=16 QoR-15 points; Pr=95%); and higher quality of life at 30- and 90-days (MD=6.94 and 6.13 QLQ score; Pr=95% and Pr=94%); and lower anxiety (MD=-2.03; Pr=94%). No meaningful between-group differences were observed for hospital length of stay, hospital readmissions or ED presentations.
Conclusions: This pilot trial provides the first RCT evidence that a co-designed ERAS-focused digital behavioural intervention may improve early mobilisation and patient-reported recovery following breast cancer surgery. The observed clinically meaningful improvements in mobilisation, Quality of Recovery and Anxiety provide proof-of-concept and support evaluation in a fully-powered multicentre RCT.