Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study.
Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study.
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DOI：
10.1136/bmjopen-2017-017002
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发表时间：
2017-06-24
期刊：
影响因子：
2.9
通讯作者：
Gramlich L
中科院分区：
文献类型：
--
作者：
Gillis C;Gill M;Marlett N;MacKean G;GermAnn K;Gilmour L;Nelson G;Wasylak T;Nguyen S;Araujo E;Zelinsky S;Gramlich L
探索在术后增强恢复（ERAS）计划中接受结直肠手术的患者的经验。使用这些经验数据为框架的开发提供信息，以支持ERAS中持续的、有意义的患者参与。采用焦点小组和叙事访谈的定性患者主导研究。数据进行了分析，迭代使用的分解扎根理论的方法。加拿大阿尔伯塔的五个三级保健中心，遵循ERAS方案。27例在过去12个月内接受结直肠手术的患者通过目的性抽样招募。七名患者参加了一个共同设计焦点小组，以确定和优先考虑的研究方向。对20名患者进行了叙述性访谈。患者认为ERAS计划不应仅限于围手术期，而应涵盖从诊断到康复的整个过程。在整个手术过程中改善患者体验并增强患者在ERAS中的参与度的实用建议包括：（1）在术前和住院期间充分解释每项协议以及协议的目的，以便患者能够在恢复过程中成为知识渊博的合作伙伴;（2）将ERAS指南扩展到手术前阶段，使患者能够在情感、心理和身体上为手术做好准备;（3）将ERAS指引扩展至家居康复期，以避免病人及家属面对压力;（4）考虑启动一项计划，让有经验的病人可提供同侪支援;（5）不能一概而论，需要在标准化途径内作出个人化的调整。根据这些数据，并通过与ERAS阿尔伯塔利益相关者的协商，ERAS团队开发了一个矩阵，以指导患者在三个层面上持续参与手术护理和行动：个人，单位和ERAS系统。这项以患者为主导的研究对ERAS患者的需求产生了新的见解，并为改善患者体验和结局的框架的开发提供了信息。
Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. Five tertiary care centres in Alberta, Canada, following the ERAS programme. Twenty-seven patients who had undergone colorectal surgery in the last 12 months were recruited through purposive sampling. Seven patients participated in a codesign focus group to set and prioritise the research direction. Narrative interviews were conducted with 20 patients. Patients perceived that an ERAS programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to recovery. Practical recommendations to improve the patient experience across the surgical continuum, and enhance patient engagement within ERAS included: (1) fully explain every protocol, and the purpose of the protocol, both before surgery and while in-hospital, so that patients can become knowledgeable partners in their recovery; (2) extend ERAS guidelines to the presurgery phase, so that patients can be ready emotionally, psychologically and physically for surgery; (3) extend ERAS guidelines to the recovery period at home to avoid stressful situations for patients and families; (4) consider activating a programme where experienced patients can provide peer support; (5) one size does not fit all; personalised adaptations within the standardised pathway are required. Drawing upon these data, and through consultation with ERAS Alberta stakeholders, the ERAS team developed a matrix to guide sustained patient involvement and action throughout the surgical care continuum at three levels: individual, unit and ERAS system. This patient-led study generated new insights into the needs of ERAS patients and informed the development of a framework to improve patient experiences and outcomes.
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影响因子：
3.4
作者：
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通讯作者：
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DOI：
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发表时间：
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期刊：
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作者：
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