Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Preventative Medicine, University of Utah, Salt Lake City, Utah.
J Surg Res. 2020 Jun;250:12-22. doi: 10.1016/j.jss.2019.12.034. Epub 2020 Jan 31.
Racial/ethnic disparities in surgical outcomes exist. Enhanced recovery programs (ERPs) have reduced some racial/ethnic disparities, but it remains unclear if disparities in experiences are also reduced. The purpose of this study was to use qualitative methods to better understand the surgical experience for African-American and Caucasian patients in the setting of an ERP.
Using purposeful sampling at a minority-serving institution, we recruited African-American and Caucasian patients who had undergone colorectal surgery under an ERP to six focus groups. Participants identified barriers and facilitators to a positive, or negative, surgical experience. Audio recordings were transcribed and analyzed using an indicative thematic approach with NVivo 10 software (QSR International).
Forty-three patients (15 African-Americans and 28 Caucasians) participated in six focus groups. Six themes were identified by patients to be important in surgery: 1) knowledge about colorectal surgery, 2) obtaining information, 3) quality of information, 4) setting expectations about surgery, 5) following preoperative and postoperative instructions, and 6) confidence in surgery outcomes. For both racial/ethnic groups, patients felt that more information could have been provided, information should be given at their level of understanding, and trust in the physician made them feel confident in a positive outcome. African-American patients described experiences of having incorrect or no expectations on surgical outcomes, being provided inconsistent information, and feeling misled. African-Americans also described following instructions from family members and valued the importance of diet and exercise in recovery.
African-American and Caucasian surgical patients have varied surgical experiences even under an ERP. All patients, however, valued the ability to obtain, process, and understand health information during the surgical process. These elements define "health literacy" and suggest the importance of providing health literacy-sensitive care in surgery.
手术结果存在种族/民族差异。 强化康复计划（ERPs）已经减少了一些种族/民族差异，但尚不清楚体验方面的差异是否也有所减少。本研究的目的是使用定性方法更好地了解 ERP 环境中非洲裔美国人和白种人患者的手术经历。
在少数民族服务机构中，通过目的性抽样，我们招募了在 ERP 下接受结直肠手术的非裔美国人和白种人患者，参加了六个焦点小组。参与者确定了对积极或消极手术体验的障碍和促进因素。使用 NVivo 10 软件（QSR International）以指示性主题方法对音频记录进行转录和分析。
43 名患者（15 名非裔美国人和 28 名白种人）参加了六个焦点小组。患者确定了 6 个对手术重要的主题：1）结直肠手术知识，2）获取信息，3）信息质量，4）对手术的期望，5）遵循术前和术后的指示，以及 6）对手术结果的信心。对于两个种族/民族群体，患者都感到可以提供更多的信息，信息应该根据他们的理解水平提供，并且对医生的信任使他们对积极的结果有信心。非裔美国患者描述了对手术结果的期望不正确或没有期望，提供了不一致的信息，并感到被误导。非裔美国人还描述了遵循家庭成员的指示，并重视饮食和运动在康复中的重要性。
即使在 ERP 下，非裔美国人和白种人手术患者的手术经历也有所不同。但是，所有患者都重视在手术过程中获得，处理和理解健康信息的能力。这些元素定义了“健康素养”，并表明在手术中提供健康素养敏感护理的重要性。
