An interpretative phenomenological analysis of the patient experience of awake craniotomy: Brain tumour diagnosis to discharge

Abstract

Thesis AbstractIntroduction. This thesis explored patient experiences of awake craniotomy.Existing literature is scarce and dominated by quantitative methodologies. More recently two qualitative studies have provided a rich, but contrasting, understanding of the patients" experience of awake craniotomy.The methodological weaknesses of the existing literature are addressed, and the rationale for the study justified. Objectives.The aim of the study was to explore seven participants" experiences of awake craniotomy using interpretative phenomenological analysis.Methods. Single-site ethical approval was gained to conduct the study in one NHS Trust. All potential participants were approached who had undergone the awake craniotomy procedure at the NHS Trust. Semi-structured interviews were conducted with participants. Interviews were transcribed verbatim and analysed using an interpretative phenomenological analysis framework.Results. Analysis of transcripts yielded three superordinate themes: selfpreservation, operation environment and information. The superordinate themes were interpreted as interconnected with each other, as well as embedded in a core theme: relationship with the neurosurgeon. The three superordinate themes are presented and discussed within the journal article.The extended paper elaborates on two of these superordinate themes. References 93Appendices 107 Tables Table 1: Interview Schedule 6 Table 2: Participant Information 9 List of AbstractObject: Previous research exploring the patient experience of awake craniotomy has yielded inconsistent results. In the current study the authors aimed to explore the lived experience of having undergone an awake craniotomy in the United Kingdom.Methods: Seven participants took part in the study, which used a qualitative research methodology. Each participant was interviewed using a semi-structured interview schedule. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis.Results: Three superordinate themes: self-preservation, operation environment and information were identified. It was interpreted that each of these themes was embedded in a core theme: relationship with the neurosurgeon. Conclusions:The relationship with the neurosurgeon appears crucial to the patient experience of awake craniotomy: from brain tumour diagnosis to discharge. This knowledge requires consideration in clinical settings and could lead to improved delivery of care in the future.

Patients’ experiences and care needs during the diagnostic phase of an integrated brain cancer pathway: A case study

“…These patients further expressed that they did not just want their surgeon to be capable and confident but also to show compassion, as signs of compassion was interpreted as the neurosurgeon could be trusted and would act humanely (Rozmovits et al., ). In addition, several studies have argued of the importance of a providing a stable relationship with members of the medical staff and especially the neurosurgeon (Fletcher, Das Nair, Macniven, Basu, & Byrne, ; Philip et al., ; Rosenblum et al., ). Fletcher et al.…”

“…Fletcher et al. () found that the stable trustful relations enable patients to use self‐preservation strategies; for example, choosing to avoid information they do not feel ready to master and instead trusting the neurosurgeon completely to take over. In this way, a relationship based on trust may compensate for the lack of specific information often experienced by patients either due to the use of patients’ self‐preservation strategies, the cognitive deficits caused by the brain tumour or an impaired ability to attain information due to the overwhelming situation.…”

“…A consistent relationship with a doctor over time has also been found to be critically important in order for patients to be able to maintain and negotiate hope. Previously, studies have shown that patients’ hopes change over time, why prognostic information must be provided according to the individual patient's preferences and how much the patient is ready to know, in order to be meaningful (Fletcher et al., ; Halkett et al., ; Philip et al., ; Piil, Juhler, Jakobsen, & Jarden, ; Rosenblum et al., ). It seems reasonable to assume that having a personal relationship would allow for the doctor to easier identify the individual information needs and preferences of the patient.…”

“…Previous research has highlighted the importance of ensuring consistent information to patients throughout their disease trajectory (Fletcher et al., ; Philip et al., ; Rosenblum et al., ). However, we identified maintaining continuity could be challenging due to the many different healthcare providers involved in the IBCP.…”

What really matters? A multi-view perspective of one patient’s hospital experience

“…While care processes, at least regarding medication management, continue to appear routinised, meaningful relationships between the recipients and providers can be formed which is in contrast to the literature suggesting routines act as a deterrent to this process (McCormack, Karlsson, Dewing, & Lerdal, 2010;Wolf et al, 2012). Establishing a personal connection with the doctor in particular appears to impact the patient's emotional wellbeing, however this could be due to the existence of a unique 'awake craniotomy' patient-to-neurosurgeon relationship (Fletcher, das Nair, Macniven, Basu, & Byrne, 2012).…”