Department of Vascular Surgery, Concord Repatriation General Hospital, Concord West, NSW, Australia; The University of Sydney, Concord Clinical School, Concord West, NSW, Australia; Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord West, NSW, Australia.
Department of Vascular Surgery, Concord Repatriation General Hospital, Concord West, NSW, Australia; The University of Sydney, Concord Clinical School, Concord West, NSW, Australia.
J Surg Res. 2019 Nov;243:289-300. doi: 10.1016/j.jss.2019.05.055. Epub 2019 Jun 26.
Chronic limb-threatening ischemia (CLTI) is the debilitating end stage of peripheral artery disease, causing patients to experience low quality of life and poor health outcomes. It is unknown which aspects of care patients with CLTI value. This pilot qualitative study aims to explore patients' concerns and values related to CLTI treatment, to better inform patient-centered care.
A qualitative study design was piloted to explore the experiences of patients with CLTI undergoing elective vascular surgery. In-depth, semistructured interviews were recorded preoperatively and 3 mo after discharge. Transcribed interviews were analyzed using content analysis, to derive patient-centered themes. Findings were mapped to a framework of patient-centered care.
Twelve interviews from six participants were analyzed. Five themes related to participant experiences of CLTI were identified: treatment and diagnosis, concerns about symptoms, limitations in physical function, social function, and emotional function. Participants expressed how CLTI intruded on all aspects of their lives. Framework analysis demonstrated CLTI patients valued patient-centered care relating to both relational and functional aspects of care. In particular, participants valued supportive and trustworthy care, in addition to integrated, holistic care that recognized the patient in the context of their overall health and life.
Feasibility was demonstrated for both study design and methodology. Data obtained from interviews were sufficiently "rich and thick" in quality and quantity to allow for common themes related to experience and health care values in patients with CLTI to be identified. If confirmed in future studies, these findings will enhance patient-centered care in CLTI.
慢性肢体威胁性缺血（CLTI）是外周动脉疾病的衰弱终末期，导致患者生活质量下降，健康状况不佳。目前尚不清楚 CLTI 患者重视哪些方面的护理。这项初步的定性研究旨在探讨 CLTI 患者对治疗的关注和价值观，以便更好地提供以患者为中心的护理。
采用定性研究设计，初步探讨接受选择性血管手术的 CLTI 患者的体验。在术前和出院后 3 个月记录深入的半结构式访谈。使用内容分析对转录后的访谈进行分析，得出以患者为中心的主题。研究结果映射到以患者为中心的护理框架。
对六名参与者中的十二次访谈进行了分析。确定了五个与参与者 CLTI 体验相关的主题：治疗和诊断、对症状的担忧、身体功能受限、社会功能和情绪功能。参与者表示 CLTI 如何侵入他们生活的方方面面。框架分析表明，CLTI 患者重视与护理的关系和功能方面相关的以患者为中心的护理。特别是，参与者重视支持性和值得信赖的护理，以及综合、整体的护理，这种护理认识到患者在其整体健康和生活背景下的情况。
研究设计和方法均具有可行性。访谈中获得的数据在质量和数量上都“丰富而详实”，足以确定 CLTI 患者在体验和医疗保健价值观方面的共同主题。如果在未来的研究中得到证实，这些发现将增强 CLTI 中的以患者为中心的护理。
