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Erschienen in: Supportive Care in Cancer 8/2016

19.03.2016 | Original Article

‘Am I really ready to go home?’: a qualitative study of patients’ experience of early discharge following an enhanced recovery programme for liver resection surgery

verfasst von: T. Vandrevala, V. Senior, L. Spring, L. Kelliher, C. Jones

Erschienen in: Supportive Care in Cancer | Ausgabe 8/2016

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Abstract

Purpose

Fast-track surgery or enhanced recovery programmes (ERP) have been shown to improve patient outcomes with shorter post-operative recovery times, fewer complications and more cost-effective care amongst the reported benefits. Traditionally, the effectiveness of ERPs have been assessed by measuring clinical outcomes, with the patient experience often being neglected. The aim of this qualitative study was to ascertain patients’ expectations and experiences of fast-track surgery and recovery at home within the setting of an enhanced recovery programme (ERP).

Method

Twenty patients enrolled in the treatment group of the randomised controlled trial ‘Enhanced recovery in liver resection surgery’ were interviewed pre-operatively and 6 weeks post-surgery. Transcripts were analysed using thematic analysis.

Results

Patients approached the surgery with a sense of renewed hope. Involvement with the ERP was viewed positively, and having milestones to aim for gave patients a sense of purpose. Many felt that real recovery from surgery began at home and so felt positive about having an early discharge. Patients did report some concerns about being discharged early and those who failed to meet milestones or were readmitted to hospital experienced this as failure.

Conclusions

This qualitative data demonstrates some of the complexities of patients’ expectations and experiences of the ERP. Whilst patients generally experience the ERP positively, they also have concerns about the process. The study highlights areas where additional support may be needed for patients enrolled in ERPs and discharged early.
Literatur
1.
Zurück zum Zitat Gouvas et al (2009) Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24:1,119–1,131CrossRef Gouvas et al (2009) Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24:1,119–1,131CrossRef
2.
Zurück zum Zitat Grover M (2010) Enhanced recovery after colorectal surgery. Curr Anaesth Crit Care 21:121–124CrossRef Grover M (2010) Enhanced recovery after colorectal surgery. Curr Anaesth Crit Care 21:121–124CrossRef
3.
Zurück zum Zitat Jones C et al (2013) Randomized clinical trial on enhanced recovery versus standard care following open liver resection. BJS 100:1015–1024CrossRef Jones C et al (2013) Randomized clinical trial on enhanced recovery versus standard care following open liver resection. BJS 100:1015–1024CrossRef
4.
Zurück zum Zitat Varadhan KK et al (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomised controlled trials. Clin Nutr 29:434–440CrossRefPubMed Varadhan KK et al (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomised controlled trials. Clin Nutr 29:434–440CrossRefPubMed
5.
7.
Zurück zum Zitat Preston SR et al (2013) Impact of a multidisciplinary standardized clinical pathway on perioperative outcomes in patients with oesophageal cancer. Br J Surg 100:105–112CrossRefPubMed Preston SR et al (2013) Impact of a multidisciplinary standardized clinical pathway on perioperative outcomes in patients with oesophageal cancer. Br J Surg 100:105–112CrossRefPubMed
8.
Zurück zum Zitat Walter C et al (2008) Patients’ perceptions of pre-operative enhanced information leaflets for fast-track colorectal resections: a qualitative study. CARE 2:72–93 Walter C et al (2008) Patients’ perceptions of pre-operative enhanced information leaflets for fast-track colorectal resections: a qualitative study. CARE 2:72–93
9.
Zurück zum Zitat Khan S et al (2010) Quality of life and patient satisfaction with enhanced recovery protocols. Color Dis 12:1175–1182CrossRef Khan S et al (2010) Quality of life and patient satisfaction with enhanced recovery protocols. Color Dis 12:1175–1182CrossRef
10.
11.
Zurück zum Zitat Levy BF et al (2011) Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing colorectal surgery. Br J Surg 98:1068–1078CrossRefPubMed Levy BF et al (2011) Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing colorectal surgery. Br J Surg 98:1068–1078CrossRefPubMed
12.
Zurück zum Zitat Feldman LS, Lee L, Fiore J (2015) What outcomes are important in the assessment of enhanced recovery after surgery (ERAS) pathways? Can J Anesth 62:120–130CrossRefPubMed Feldman LS, Lee L, Fiore J (2015) What outcomes are important in the assessment of enhanced recovery after surgery (ERAS) pathways? Can J Anesth 62:120–130CrossRefPubMed
13.
Zurück zum Zitat Lassen K et al (2009) Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg 144:961–969CrossRefPubMed Lassen K et al (2009) Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg 144:961–969CrossRefPubMed
14.
Zurück zum Zitat Savikko J et al (2015) Enhanced recovery protocol after liver resection. BJS 102:1526–1532CrossRef Savikko J et al (2015) Enhanced recovery protocol after liver resection. BJS 102:1526–1532CrossRef
15.
Zurück zum Zitat Wang H et al (2013) Short-term quality of life in patients undergoing colonic surgery using enhanced recovery after surgery program versus conventional perioperative management. Qual Life Res. doi:10.1007/s11136-015-0996-5 Wang H et al (2013) Short-term quality of life in patients undergoing colonic surgery using enhanced recovery after surgery program versus conventional perioperative management. Qual Life Res. doi:10.​1007/​s11136-015-0996-5
19.
Zurück zum Zitat Norlyk A, Harder I (2009) After colonic surgery: the lived experience of participating in a fast-track surgery. Intern J Qual Stud Health Well-being 4:170–180CrossRef Norlyk A, Harder I (2009) After colonic surgery: the lived experience of participating in a fast-track surgery. Intern J Qual Stud Health Well-being 4:170–180CrossRef
21.
Zurück zum Zitat Archer S, Montague J, Bali A (2014) Exploring the experience of an enhanced recovery programme for gynecological cancer patients: a qualitative study. Perioper Med 3:2. doi:10.1186/2047-0525-3-2 CrossRef Archer S, Montague J, Bali A (2014) Exploring the experience of an enhanced recovery programme for gynecological cancer patients: a qualitative study. Perioper Med 3:2. doi:10.​1186/​2047-0525-3-2 CrossRef
22.
Zurück zum Zitat Wagner L et al (2004) Patient and staff (doctors and nurses) experiences of abdominal hysterectomy in accelerated recovery programme. Dan Med Bull 51:418–421PubMed Wagner L et al (2004) Patient and staff (doctors and nurses) experiences of abdominal hysterectomy in accelerated recovery programme. Dan Med Bull 51:418–421PubMed
24.
Zurück zum Zitat Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101, ISSN 1478-0887CrossRef Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101, ISSN 1478-0887CrossRef
25.
Zurück zum Zitat Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24:105–112CrossRefPubMed Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24:105–112CrossRefPubMed
26.
Zurück zum Zitat Sahlsten MJ et al (2009) Nurse strategies for optimising patient participation in nursing care. Scand J Caring Sci 23:490–497CrossRefPubMed Sahlsten MJ et al (2009) Nurse strategies for optimising patient participation in nursing care. Scand J Caring Sci 23:490–497CrossRefPubMed
27.
Zurück zum Zitat Bruce J et al (2014) Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain 155:232–243CrossRefPubMed Bruce J et al (2014) Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain 155:232–243CrossRefPubMed
28.
Zurück zum Zitat Antoni MH et al (2001) Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhanced benefit finding among women under treatment for early-stage breast cancer. Health Psychol 20:20–32CrossRefPubMed Antoni MH et al (2001) Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhanced benefit finding among women under treatment for early-stage breast cancer. Health Psychol 20:20–32CrossRefPubMed
30.
Zurück zum Zitat Jonsson CA, Stenberg A, Frisman GH (2010) The lived experiences of the early postoperative period after colorectal cancer surgery. Eur J Cancer Care 20:248–256CrossRef Jonsson CA, Stenberg A, Frisman GH (2010) The lived experiences of the early postoperative period after colorectal cancer surgery. Eur J Cancer Care 20:248–256CrossRef
31.
Zurück zum Zitat Department of Health (2010) Ready to go? Planning the discharge and the transfer of patients from hospital and intermediate care. Department of Health, London Department of Health (2010) Ready to go? Planning the discharge and the transfer of patients from hospital and intermediate care. Department of Health, London
Metadaten
Titel
‘Am I really ready to go home?’: a qualitative study of patients’ experience of early discharge following an enhanced recovery programme for liver resection surgery
verfasst von
T. Vandrevala
V. Senior
L. Spring
L. Kelliher
C. Jones
Publikationsdatum
19.03.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Supportive Care in Cancer / Ausgabe 8/2016
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-016-3158-6

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