Dean Lucy, Cowan-Dickie Siobhan, Strauss Dirk C, Humphrey Pauline, Cramp Fiona
Physiotherapy Department, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
Support Care Cancer. 2025 Feb 1;33(2):139. doi: 10.1007/s00520-025-09199-x.
The primary treatment for localised soft tissue sarcoma (STS) is surgery. Surgery for lower limb sarcoma is associated with poorer functional outcomes than other anatomical sites. Rehabilitation is essential, yet provision is not standardised, and patient experience of current service delivery is unknown. This study therefore aimed to explore patients' experiences of rehabilitation in the surgical pathway for lower limb STS at a United Kingdom (UK) specialist centre.
A qualitative, descriptive phenomenological study was undertaken to explore patients' rehabilitation experiences. Eight patients who had undergone lower limb STS surgery at a specialist centre were purposively sampled. Data were collected through semi-structured interviews and analysed using thematic analysis.
Three main themes were identified: (1) Accessing the right services at the right time. Participants described good access to inpatient rehabilitation post-operatively but delays and challenges in accessing local services affected continuity of care. Rehabilitation gaps pre-operatively, and in facilitating return to meaningful activities, were described; (2) "Communication is key" - providing knowledge and support to navigate uncertainty. Unclear and unrealistic expectations of recovery were challenging. Communication was key to patients feeling supported and facilitating access to rehabilitation; (3) The importance of person-centred rehabilitation. Collaborative, person-centred rehabilitation optimised motivation and engagement.
Participants experienced good access to inpatient rehabilitation post-operatively. In contrast, gaps and delays at other timepoints led to missed opportunities to support preparation for, and recovery from, surgery. A multidisciplinary approach across settings from diagnosis, to deliver person-centred rehabilitation, may improve access, expectation management and continuity of care.
局部软组织肉瘤（STS）的主要治疗方法是手术。下肢肉瘤手术的功能预后比其他解剖部位更差。康复至关重要，但目前康复服务的提供并不规范，患者对当前服务的体验也未知。因此，本研究旨在探讨英国一家专科中心下肢STS手术患者在手术过程中的康复体验。
采用定性、描述性现象学研究方法来探索患者的康复体验。有目的地抽取了8名在专科中心接受过下肢STS手术的患者。通过半结构化访谈收集数据，并使用主题分析法进行分析。
确定了三个主要主题：（1）在正确的时间获得正确的服务。参与者描述了术后能顺利获得住院康复服务，但在获得当地服务方面存在延迟和挑战，影响了护理的连续性。术前康复存在缺口，在促进患者恢复有意义的活动方面也存在问题；（2）“沟通是关键”——提供知识和支持以应对不确定性。对康复的不明确和不切实际的期望具有挑战性。沟通是让患者感到得到支持并促进其获得康复服务的关键；（3）以患者为中心的康复的重要性。协作式、以患者为中心的康复可优化患者的积极性和参与度。
参与者术后能顺利获得住院康复服务。相比之下，其他时间点的缺口和延迟导致了在支持手术准备和术后康复方面错失机会。从诊断开始跨机构采取多学科方法，提供以患者为中心的康复服务，可能会改善服务的可及性、期望管理和护理的连续性。
