患者对术前康复作为加速康复外科方案延伸的看法。
Patients' perspectives of prehabilitation as an extension of Enhanced Recovery After Surgery protocols.
机构信息
From the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Gillis); the Patient and Community Engagement Research program, University of Calgary, Calgary, Alta. (Gill); the Department of Medicine, University of Alberta, Edmonton, Alta. (Gramlich); the Faculty of Kinesiology, University of Calgary, Calgary, Alta. (Culos-Reed); the Departments of Oncology and of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Nelson); the Department of Surgery, School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Ljungqvist); the Department of Anesthesia, McGill University Health Centre, Montréal, Que. (Carli); and the Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Calgary, Alta. (Fenton).
出版信息
Can J Surg. 2021 Nov 2;64(6):E578-E587. doi: 10.1503/cjs.014420. Print 2021 Nov-Dec.
BACKGROUND
Enhanced Recovery After Surgery (ERAS) and prehabilitation programs are evidence-based and patient-focused, yet meaningful patient input could further enhance these interventions to produce superior patient outcomes and patient experiences. We conducted a qualitative study with patients who had undergone colorectal surgery under ERAS care to determine how they prepared for surgery, their views on prehabilitation and how prehabilitation could be delivered to best meet patient needs.
METHODS
We conducted semistructured interviews with adult patients who had undergone colorectal surgery under ERAS care within 3 months after surgery. Patients were enrolled between April 2018 and June 2019 through purposive sampling from 1 hospital in Alberta. The interview transcripts were analyzed independently by a researcher and a trained patient-researcher using inductive thematic analysis.
RESULTS
Twenty patients were interviewed. Three main themes were identified. First, waiting for surgery: patients described fear, anxiety, isolation and deterioration of their mental and physical states as they waited passively for surgery. Second, preparing would have been better than just waiting: patients perceived that a prehabilitation program could prepare them for their operation if it addressed their emotional and physical needs, provided personalized support, offered home strategies, involved family and included surgical expectations (both what to expect and what is expected of them). Third, partnering with patients: preoperative preparation should occur on a continuum that meets patients where they are at and in a partnership that respects patients' expertise and desired level of engagement.
CONCLUSION
We identified several patient priorities for the preoperative period. Integrating these priorities within ERAS and prehabilitative programs could improve patient satisfaction, experiences and outcomes. Actively engaging patients in their care might alleviate some of the anxiety and fear associated with waiting passively for surgery.
背景
加速康复外科（ERAS）和预康复计划是基于证据和以患者为中心的，但患者的有意义的投入可以进一步增强这些干预措施，以产生更好的患者结果和患者体验。我们对接受 ERAS 护理的结直肠手术后的患者进行了一项定性研究，以确定他们如何为手术做准备、他们对预康复的看法以及如何提供预康复以最好地满足患者的需求。
方法
我们对在手术后 3 个月内接受 ERAS 护理的结直肠手术后的成年患者进行了半结构式访谈。通过在阿尔伯塔省的一家医院进行目的性抽样，于 2018 年 4 月至 2019 年 6 月期间招募了患者。研究人员和经过培训的患者研究人员独立使用归纳主题分析对访谈记录进行分析。
结果
共对 20 名患者进行了访谈。确定了三个主要主题。首先，等待手术：患者描述了在等待手术时的恐惧、焦虑、孤立和身心状态恶化。其次，准备会更好：患者认为，如果预康复计划能够满足他们的情感和身体需求，提供个性化支持，提供家庭策略，包括家庭并包括手术预期（包括预期和对他们的期望），那么可以为他们的手术做好准备。第三，与患者合作：术前准备应在一个连续体上进行，以满足患者的现状，并建立一个尊重患者专业知识和期望参与程度的合作伙伴关系。
结论
我们确定了术前期间患者的一些重点。将这些重点纳入 ERAS 和预康复计划中可以提高患者的满意度、体验和结果。积极参与患者的护理可能会减轻一些与被动等待手术相关的焦虑和恐惧。
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