Developing patient education to enhance recovery after colorectal surgery through action research: a qualitative study

Abstract

ObjectivesTo understand the role of preoperative education for patients undergoing colorectal surgery by involving patients, carers and staff in: (1) identifying its perceived value and deficits for enhanced recovery; (2) modifying current education practices to address educational deficits; and (3) evaluating these changes for preparing patients to enhance their recovery.DesignQualitative study of three cycles of action research using mixed methods within a 24-month naturalistic enquiry to identify, implement and evaluate changes through observations, questionnaires, semistructured longitudinal interviews, focus groups and documentation review.SettingA UK 1200-bed National Health Service (NHS) hospital providing colorectal surgery in a small city in a rural county.ParticipantsNinety-sevenpatients having colorectal surgery, 19 carers and 22 clinical staff.ResultsThemes identified were: (1) knowledge and engagement; (2) situated understanding and confidence building; and (3) partnership and proactive involvement in enhancing recovery. All patients articulated needs to prepare mentally and physically to plan for colorectal surgery and rehabilitation. Patients and carers wanted to counter uncertainty about medical procedures: likely bodily changes, recovery timescales and future. They therefore sought as much personalised, relevant information as possible about their disease, planned surgery and recovery. Staff implemented preoperative education to more specifically inform and respond multimodally to individual needs.ConclusionsPatients wanted to be proactively involved in managing their recovery to re-engage with their everyday lives. Preoperative education supported this through developing patients’ situated understanding of hospital and bodily processes related to colorectal surgery. Situated understanding was achieved through educational product to give knowledge and processes promoting engagement. Multimodal, comprehensive and timely preoperative education on the whole patient pathway facilitates active engagement. Situated understanding increased patients’ confidence to work in partnership with healthcare professionals and proactively self-manage recovery.

Patient experience of health and care when undergoing colorectal surgery within the ERAS program

“…In response to the open-ended questions (step 2), the patients expressed "the meaning of information and communication" and described a feeling of safety, which was of great importance for how the patients were able to focus on their rehabilitation postoperatively. This is in agreement with other studies which claim that understandable information (Larsson et al 2011) makes it easier for patients to handle the preand postoperative period as they get an insight into their health condition and treatment, as well as a feeling of increased safety and participation in their self-care (Poland et al 2017).…”

Patient education about recovery after colorectal surgery: systematic scoping review

“…In some settings, this has facilitated greater alignment of patient and clinician perceptions of risk, such as the choice of regional anaesthesia (rather than general anaesthesia) during orthopaedic procedures [24]. In the setting of colorectal surgery, previous qualitative evidence has shown that patients want to be pro‐actively involved in their recovery to facilitate a return to their everyday lives [25]. In a recent patient focus group, highly emotional situations and poor information design (i.e.…”

How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study

“… 5 9 The principle of individual tailoring suggests a process of developing individualised knowledge, which has been shown to be important for patients. 8 Our results suggest that individual tailoring is enacted as a comprehensive practice, which entails actively engaging with the patients’ knowledge about their life and experiences in order to translate generalised knowledge into meaningful knowledge within the frame of the patient’s life world.…”

“…In a recent publication in BMJ Open , Poland et al 8 describe that individual tailoring help patients build ‘individually relevant knowledge of their condition’, which in turn ‘support a situated understanding’. This clarifies that individual tailoring is not merely a question of individually adapted education, but that patients need to develop individualised knowledge.…”