Kennedy Deborah, Wainwright Amy, Pereira Lucy, Robarts Susan, Dickson Patricia, Christian Jennifer, Webster Fiona
Sunnybrook Holland Orthopaedic and Arthritic Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.
School of Rehabilitation Science, McMaster University, 1400 Main St. W, Hamilton, ON, L8S 1C7, Canada.
BMC Musculoskelet Disord. 2017 Oct 12;18(1):413. doi: 10.1186/s12891-017-1769-9.
Quality health information is key to patient engagement, self-management and an enhanced healthcare experience. There is strong evidence to support involving patients and their families in the development and evaluation of health-related educational material. These factors were the impetus for our high volume joint replacement centre to undertake a qualitative study to elicit patient experiences to inform the development of effective strategies and education along the care continuum for hip and knee replacement.
Purposively selected patients from postoperative follow-up clinics were recruited to participate in a focus group or telephone interview. We developed a semi-structured interview guide that addressed four specific aspects of the patient's experience with educational material: pre-surgery, hospital stay, recovery period and future recommendations. The focus groups and interviews continued to the point of saturation and were audio-recorded and transcribed verbatim. Interview transcripts were coded and then inductively organized into larger categories using thematic analysis.
Six focus groups and seven telephone interviews were conducted, totalling 32 participants. One of the key themes that emerged was a need for more education concerning pain management post-operatively; specifically, patients wanted more information on expected levels of pain, pain medication usage, management of side effects and guidelines for weaning off the medication. There was surprising variability in patients' descriptions of their pre-surgery, surgery and recovery experiences. These corresponded to an equally diverse range of preferences for educational content, delivery and timing. Many patients reported using the web while others preferred traditional formats for information delivery. There was some interest in receiving education using mobile technology.
Our findings validate the importance of multi-modal patient education tailored to individual preferences and experiences, which may differ according to such characteristics as gender and age. The gap in pain management information is a critical finding for healthcare providers working with patients undergoing joint replacement. Developing pain management education in different formats that addresses frequently asked questions will enhance patient engagement and, their overall experience and recovery.
高质量的健康信息是患者参与、自我管理及提升医疗体验的关键。有充分证据支持让患者及其家属参与健康相关教育材料的开发与评估。这些因素促使我们这个大量开展关节置换手术的中心进行一项定性研究，以了解患者的经历，从而为制定髋关节和膝关节置换护理连续过程中的有效策略及教育提供依据。
从术后随访诊所中特意挑选患者参与焦点小组讨论或电话访谈。我们制定了一份半结构化访谈指南，涉及患者在教育材料方面经历的四个具体方面：术前、住院期间、康复期及未来建议。焦点小组讨论和访谈持续到饱和点，并进行了录音和逐字转录。访谈记录进行了编码，然后使用主题分析归纳整理为更大的类别。
共进行了6次焦点小组讨论和7次电话访谈，共有32名参与者。出现的一个关键主题是术后疼痛管理方面需要更多教育；具体而言，患者希望获得更多关于预期疼痛程度、止痛药物使用、副作用管理及停药指南的信息。患者对术前、手术及康复经历的描述存在惊人的差异。这些差异与对教育内容、形式及时间的同样多样的偏好相对应。许多患者报告使用网络，而其他患者则更喜欢传统的信息传递形式。对使用移动技术接受教育有一定兴趣。
我们的研究结果证实了根据个人偏好和经历进行多模式患者教育的重要性，这些偏好和经历可能因性别和年龄等特征而有所不同。疼痛管理信息方面的差距对于为接受关节置换手术的患者提供护理的医疗服务提供者来说是一个关键发现。以不同形式开展解决常见问题的疼痛管理教育将提高患者的参与度及其整体体验和康复效果。
