Dy Christopher J, Brogan David M, Rolf Liz, Ray Wilson Z, Wolfe Scott W, James Aimee S
Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.
Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO.
J Hand Surg Glob Online. 2021 Jan;3(1):30-35. doi: 10.1016/j.jhsg.2020.10.010. Epub 2020 Nov 21.
Increasing emphasis has been placed on multidisciplinary care for patients with traumatic brachial plexus injury (BPI), and there has been a growing appreciation for the impact of psychological and emotional components of recovery. Because surgeons are typically charged with leading the recovery phase of BPI, our objective was to build a greater understanding of surgeons' perspectives on the care of BPI patients and potential areas for improvement in care delivery.
We conducted semistructured qualitative interviews with 14 surgeons with expertise in BPI reconstruction. The interview guide contained questions regarding the surgeons' practice and care team structure, their attitudes and approaches to psychological and emotional aspects of recovery, and their preferences for setting patient expectations. We used inductive thematic analysis to identify themes.
There was a high degree of variability in how surgeons addressed emotional and psychological aspects of recovery. Whereas some surgeons embraced the practice of addressing these components of care, others felt strongly that BPI surgeons should remain focused on technical aspects of care. Several participants described the emotional toll that caring for BPI patients can have on surgeons and how this concern has affected their approach to care. Surgeons also recognized the importance of setting preoperative expectations. There was an emphasis on setting low expectations in an attempt to minimize the risk for dissatisfaction. Surgeons described the challenges in effectively counseling patients about a condition that is prone to substantial injury heterogeneity and variability in functional outcomes.
Our results demonstrate wide variability in how surgeons address emotional, psychological, and social barriers to recovery for BPI patients.
Best practices for BPI care are difficult to establish because of the relative heterogeneity of neurologic injury, the unpredictable impact and recovery of the patient, and the substantial variability in physician approach to the care of these patients.
对于创伤性臂丛神经损伤（BPI）患者的多学科护理越来越受到重视，人们也越来越认识到康复过程中心理和情感因素的影响。由于外科医生通常负责引领BPI的康复阶段，我们的目标是更深入地了解外科医生对BPI患者护理的看法以及护理过程中潜在的改进领域。
我们对14名擅长BPI重建的外科医生进行了半结构化定性访谈。访谈指南包含有关外科医生的执业情况和护理团队结构、他们对康复过程中心理和情感方面的态度及方法，以及他们对设定患者期望的偏好等问题。我们采用归纳主题分析法来确定主题。
外科医生在处理康复过程中的情感和心理方面存在很大差异。一些外科医生接受处理护理这些方面的做法，而另一些医生则强烈认为BPI外科医生应专注于护理的技术方面。几位参与者描述了护理BPI患者可能给外科医生带来的情感负担以及这种担忧如何影响他们的护理方法。外科医生也认识到设定术前期望的重要性。强调设定较低期望以尽量降低不满风险。外科医生描述了在有效向患者咨询一种易于出现严重损伤异质性和功能结果差异的疾病时所面临的挑战。
我们的结果表明，外科医生在处理BPI患者康复过程中的情感、心理和社会障碍方面存在很大差异。
由于神经损伤的相对异质性、患者不可预测的影响和恢复情况以及医生对这些患者护理方法的巨大差异，很难确立BPI护理的最佳实践。
