Spine Surgery Patient Navigators (2025-2026)

Background

Chronic back pain is one of the top five leading causes of disability worldwide, with about 25% of adults in the United States being affected by chronic back pain at any given time. Back pain can be managed through non-surgical and surgical treatments, with surgery reserved for impairments in neurologic function, medically refractory pain, deformity or local control of disease.

Studies have demonstrated that patients of certain demographics have a higher burden of disease. Low-income patients have longer hospital stays after surgery and more frequently go to the emergency room after discharge. Non-Hispanic Black people and Hispanic people are undertreated for pain and less likely to undergo surgery, despite reporting more severe back pain and disability. These groups may also face an increased risk of complications during or after back surgery.

Optimal outcomes are achieved when the management of back pain is multimodal. Interventions providing social and emotional support after surgery can decrease stress, anxiety and hospital length of stay, while physical movement after surgery decreases length of stay and risk of complications.

Project Description

Building on the work of the 2024-2025 team, this project team aims to improve health outcomes for patients undergoing spine surgery. The team will work directly with surgical spine patients at Duke Hospital with three primary aims:

• Improve patients’ access to and utilization of existing healthcare resources. Barriers to optimal surgical care and MyChart utilization will be identified at the first appointment with a spine surgeon. All patients meeting inclusion criteria will receive a handout of community resources. For patients not enrolled in MyChart, team members will provide education on patient portal use, including enrolling, reviewing results and messaging providers. Pre-intervention surveys will assess socio- demographic data, barriers to care, psychosocial distress, perceived social support, mobility and MyChart use. Post-intervention surveys will assess the use of community resources and MyChart.
• Expand the social support network of patients undergoing spine surgery. Preoperatively, team members will meet patients and identify goals of care in conjunction with their spine provider. Postoperatively, team members will serve as an additional liaison between the patient and providers via biweekly calls, during which they will check in on the patient’s mental and physical health. Phone calls will continue until the patient’s first post-op visit, which the student may attend.
• Improve patients’ physical status and mobility in the immediate post-operative period. Students will visit their patients postoperatively and assist them in completing postoperative mobility exercises. Before discharge, students will discuss and demonstrate the recommended mobility exercises with patients. Team members will measure post-op outcomes such as length of hospital stay, rates of 30-day infections, blood clots and readmission. The team will also compare patient-reported mobility in the preoperative and postoperative surveys.

Anticipated Outputs

Poster and presentation abstracts; presentation to the Duke Spine Patient Advocacy Group; presentation at Neurosurgery Grand Rounds; preliminary data submitted to private foundation or NIH

Student Opportunities

Ideally, this project team will include 5 graduate students and 10 undergraduate students with backgrounds in neuroscience, public policy, public health, biology or biological sciences and/or global health. Students with interests in community engagement, patient engagement, clinical and quality improvement research and achieving health equity are encouraged to apply, especially those from underrepresented racial and ethnic minorities.

Students will have the opportunity to deepen their understanding of how socioeconomic factors impact patients’ healthcare experiences. Team members will work directly with patients and have opportunities to attend clinic visits. Students will have an opportunity to shadow at least twice in a spine clinic for the academic year. Additionally, students will receive personal mentorship and guidance on pursuing a career in health care, public health and/or health policy.

Graduate students will build leadership and mentorship skills and apply their clinical knowledge to teach undergraduate students how to interact with patients and maintain proper etiquette for the clinic. All students will contribute to a Grand Rounds presentation for the Duke Department of Neurosurgery, as well as presentations to the Duke Spine Patient Advocacy Group. All students will contribute to at least two scholarly contributions (e.g., publications, abstract for conference or presentation).

An optional part-time summer opportunity will also be available for team members immediately following the 2025 spring semester.

Timing

Summer 2025 – Summer 2026

• Summer 2025 (optional): Continue patient enrollment and engagement
• Fall 2025: Attend introductory lectures; engage in training for patient engagement; continue patient enrollment
• Spring 2026: Serve as navigators for patients; participate in shadowing opportunities; produce work on data analysis; summarize work data analysis for publication
• Summer 2026 (optional): Continue patient enrollment and engagement

Crediting

Academic credit available for fall and spring semesters; summer funding available

See related team Spine Surgery Patient Navigators (2024-2025).