Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA.
Surg Endosc. 2023 Nov;37(11):8663-8669. doi: 10.1007/s00464-023-10283-8. Epub 2023 Jul 27.
Delaying an elective operation to mitigate risk factors improves patient outcomes. Elective ventral hernia repair is one such example. To address this issue, we developed a pre-operative optimization clinic to support high-risk patients seeking elective ventral hernia repair. Unfortunately, few patients progressed to surgery. Within this context, we sought to understand the barriers to behavior change among these patients with the goal of improving care for patients undergoing elective surgery.
We performed semi-structured, qualitative interviews with 20 patients who were declined ventral hernia repair due to either active tobacco use or obesity. Patients were recruited from a pre-operative optimization clinic at an academic hospital. Interviews sought to characterize patients' perceived barriers to behavior change. Interviews were concluded once thematic saturation was reached. We used an inductive thematic analysis to analyze the data. All data analysis was performed using MAXQDA software.
Among 20 patients (mean age 50, 65% female, 65% White), none had yet undergone ventral hernia repair. While most patients had a positive experience in the clinic, among those who did not, we found three dominant themes around behavior change: (1) Patient's role in behavior change: how the patient perceived their role in making behavior changes optimize their health for surgery; (2) Obtainability of offered resources: the need for more support for patients to access the recommended healthcare; and (3) Patient-provider concordance: the extent to which patients and providers agree on the relative importance of different attributes of their care.
Behavior change prior to elective surgery is complex and multifaceted. While improving access to tobacco cessation resources and obesity management may improve outcomes for some, patients may benefit from increased on-site facilitation to promote access to resources as well as the use of patient-facing decision support tools to promote patient-provider concordance.
延迟择期手术以减轻风险因素可改善患者预后。择期腹疝修补术就是一个例子。为了解决这个问题，我们开设了术前优化诊所，为寻求择期腹疝修补术的高危患者提供支持。然而，只有少数患者接受了手术。在这种情况下，我们试图了解这些患者行为改变的障碍，以改善接受择期手术患者的护理。
我们对 20 名因吸烟或肥胖而被拒绝行腹疝修补术的患者进行了半结构化的定性访谈。患者从学术医院的术前优化诊所招募。访谈旨在描述患者对行为改变的感知障碍。一旦达到主题饱和，就会结束访谈。我们使用归纳主题分析来分析数据。所有数据分析均使用 MAXQDA 软件进行。
在 20 名患者中（平均年龄 50 岁，女性占 65%，白人占 65%），没有人接受过腹疝修补术。虽然大多数患者在诊所的体验良好，但对于那些没有接受手术的患者，我们发现了三个关于行为改变的主要主题：（1）患者在行为改变中的角色：患者如何看待自己在为手术优化健康状况方面的角色；（2）提供资源的可得性：患者需要更多的支持来获得推荐的医疗保健；（3）患者与提供者的一致性：患者和提供者在其护理的不同属性的相对重要性上的一致性程度。
择期手术前的行为改变是复杂和多方面的。虽然改善获得戒烟资源和肥胖管理的机会可能会改善一些患者的预后，但患者可能会受益于增加现场促进以促进获得资源，以及使用面向患者的决策支持工具来促进患者与提供者的一致性。
