Acceptability and feasibility of two preoperative alcohol interventions

Purpose: This mixed-methods study examined the acceptability and feasibility of two pre-operative alcohol interventions promoting alcohol use reduction during the months before and after surgery to decrease post-operative complications. Methods: Participants (n = 52) included elective surgical patients who met high-risk alcohol use criteria (AUDIT-C ≥ 5). Participants were randomized to a Brief Intervention (10-minute phone-based session) or Virtual Health Coaching (two telehealth sessions with a therapist). After each session, we collected acceptability data using Likert-type items. At the conclusion of the trial, we recruited a sub-set of participants based on intervention response (≥50% vs. <25% reduction in alcohol use) to participate in individual qualitative exit interviews. We used a semi-structured interview guide to explore intervention acceptability/efficacy and uncover aspects of the interventions to improve. We calculated descriptive statistics for quantitative data and used thematic analysis to summarize exit interviews. Results: Of 1229 patients screened, 8.30% were eligible, and 50.98% enrolled. Of those enrolled, 15.38% of participants left the trial early due to COVID-19-related surgery cancelations. Among health coaching participants, 100% found it mostly or very acceptable, and 80.00% found it mostly or very important. Among brief intervention participants, 100% found it to mostly or very acceptable. Qualitative exit interview participants described the information delivered in both interventions as new and interesting and felt that receiving it before surgery was more motivating than it would have been in other settings (e.g., primary care). Well-defined guidelines about safe perioperative alcohol use, accountability from self-tracking, and having opportunities to discuss and reflect on alcohol use with a non-judgmental professional were aspects of the intervention participants found motivating. “Non-responders” felt that the intervention wasn't a good “fit” for them because they did not view their alcohol use as 'problematic.' Conclusions: This study resulted in two acceptable interventions of varying intensities and modalities. Feasibility was impacted by COVID-19 pandemic. Qualitative interviews showed that surgery can be leveraged to motivate patients to reduce alcohol use. For some patients, however, alternative approaches may be needed. Future research will determine the efficacy of these interventions in reducing alcohol use and surgical complications.