Table 3.

An ‘engaging patients in ERAS’ matrix

	We inform patients	Patients inform us	Patients ‘co-lead’ and ‘co-design’ with us	Patients lead
Individual care level (Patients are engaged in their own care)	- Patients are provided with clear information about ERAS throughout the surgical trajectory, in ways that work for them. - Preoperative education information is shared with patients prior to their clinic appointment so that they can ask informed questions. - Information needs to be repeated.	- Patients tell us what’s important to them across the surgical trajectory and this information guides their care.	- Patients are involved in shared decision making. - Patients are involved in the development of mechanisms, such as apps or log books, to track recovery.	- Patients make their own decisions based on information and options provided. - Patients have the opportunity to talk with peers (eg, an online support forum).
Unit level (Patients are engaged at the Unit level)	- The unit supports staff in patient education activities.	- Patients provide feedback via short unit-specific surveys, and informal interviews; this information is shared with staff on a consistent and timely basis. - Patients are invited to share their experience at staff meetings. - Unit has a patient council.	- Patients are equal members of unit quality-improvement councils, working collaboratively with their health professional colleagues. - Patients colead unit quality improvement projects.	- Peer supporters work on units to support patient recovery. - Peer supporters obtain input from patients on their experience and outcomes.
ERAS initiative level (Patients are engaged at the ERAS level)	- The development and evaluation of ERAS preoperative education modules are informed by what patients need and want.	- ERAS database is modified to collect data on PREM/PROM. - Patient research participants are meaningfully involved throughout research processes. - ERAS has a patient council.	- Patients are members of the local and international ERAS project team. - Patients participate in the development of PROM/PREM. - Patients are members of ERAS education working groups.	- Patients are engaged as researchers. - Peer support is built into the ERAS initiative as an integral component.
The surgical continuum across which patients are engaged extends from diagnosis to recovery.
Patients choose how they want to engage, and there is recognition that this may change over time.
The knowledge and experiential expertise that patients bring, at each of these levels, is highly valued.

PREM refers to patient-reported experience measures; PROM is patient-reported outcome measures. The cells of the matrix have been populated with some examples of how patients might be involved across the engagement continuum and at the different levels. These are not meant to be recommended activities, but are simply illustrative examples of what this kind of engagement could look like. Along the base of the matrix are three foundational elements of patient engagement: (1) the knowledge and experiential expertise that patients bring, at each of these levels, is highly valued; (2) patients choose how they want to engage and there is recognition that this may change over time; and (3) the surgical trajectory across which patients are engaged extends from diagnosis to recovery at home

ERAS, Enhanced Recovery After Surgery; PREM, patient-reported experience measures; PROM, patient-reported outcome measures.