Addressing patients’ colorectal cancer needs in preoperative education

Abstract

Purpose -The purpose of this paper is to understand and develop ways to enhance patients' experiences of preoperative education received prior to surgery for colorectal cancer. Design/methodology/approach -Based in the UK, three-action research cycles were undertaken to evaluate preoperative education, identify changes seen by patients and staff as likely to improve the service and to re-evaluate such changes following implementation. Data in each cycle were collected from: observations of clinic interactions; patient questionnaires; individual semi-structured interviews with multidisciplinary colorectal unit staff; longitudinal semi-structured interviews with patients and carers pre-surgery, two weeks post-surgery and 12 weeks post-surgery; patient and carer focus groups post-surgery; and existing educational material. Findings -In total, 138 participants shared their experiences of either giving or receiving preoperative education. Findings were themed into why patients want preoperative education, and patients' views of the educational processes. Practical implications -Patients emphasised the need for educational provision to be fully understandable, comprehensive and client-centred using a range of communication processes. Patients emphasised the need for educational provision to be more fully understandable, comprehensive and client-centred and that important messages should be reinforced using a range of media. At a time of many uncertainties for patients' lives, such education needed to encompass the experiences patients could expect, delivered by confident healthcare professionals. Originality/value -Contextualising understanding and facilitating their own actions, enabled patients to regain control in circumstances particularly disruptive of bodily and other life routines. Establishing a sense of control is confirmed as important for patient's wellbeing in preparing for surgery and postoperative rehabilitation.

The patient perspective on the preoperative colorectal cancer care pathway and preparedness for surgery and postoperative recovery—a qualitative interview study

“…22,23 Not knowing what to expect from treatment, how to deal with symptoms or how to selfcontribute to health and recovery might lead to perioperative distress. 10,13,24,25 While the importance of adequate information provision is widely acknowledged, it is sometimes unclear whether information provision adequately matches patients' information needs, 12,26,27 and sufficiently prepares patients for what to expect from surgery and recovery. 11,13 Preoperatively, patients seem to regard surgery as the most important, imminent and inevitable These results are in line with previous literature, showing that patients often are satisfied with perioperative guidance, monitoring and communication, but that receiving tailored and dosed information in the postoperative phase remains an unmet need.…”

“…The interview guide consisted of questions addressing the patient's perspectives and experiences regarding four themes: (1) organization of the preoperative surgical care pathway, (2) information provision, (3) preoperative guidance, and (4) preparedness for surgery and recovery. The themes were identified based on literature 10–13,19 and expert opinion by means of four group discussions of the multidisciplinary team in which the preoperative CRC care pathway and the patient journey were outlined in detail using value stream mapping 20 . The four themes made it possible for the interviewer to guide the participants to talk about all the aspects of the pathway.…”

“…Despite the aim of healthcare providers (HCPs) to deliver patient‐centred care, current Dutch cancer care (including the organizational structure and the provided guidance and information) is still mainly organized based on the professional's perspective. Additionally, the majority of the existing literature mainly examined postoperative experiences and survivorship care, showing that patients often experience unmet needs in information provision, emotional guidance, healthcare organization and expectation management 10–12 . Until now, little attention has been paid to the perspective of CRC patients on the current preoperative cancer care counselling, and how patients experience the period from diagnosis to surgery and recovery, both in clinical practice and in literature 9,11,13 .…”

“…Additionally, the majority of the existing literature mainly examined postoperative experiences and survivorship care, showing that patients often experience unmet needs in information provision, emotional guidance, healthcare organization and expectation management. [10][11][12] Until now, little attention has been paid to the perspective of CRC patients on the current preoperative cancer care counselling, and how patients experience the period from diagnosis to surgery and recovery, both in clinical practice and in literature. 9,11,13 Knowledge about the patient's preoperative experience, perspectives and needs is of great value for professionals initializing CRC care pathways, as well as for professionals who seek to further optimize their CRC care pathways by offering holistic and patientcentred care which might prevent patient distress and help to cope with the cancer diagnosis and following treatment.…”