"Am I Really Ready to go Home?â€: a Qualitative Study of Patients’ Experience of Fast Track Surgery

Abstract

Background: Fast track surgery or Enhanced Recovery Programs (ERP) have been shown to improve patient outcomes, speed patient recovery post-operatively and increase cost-effectiveness for patients undergoing cancer surgery. ERPs are based on improving patient education, explaining the expected milestones in the recovery period and discharge planning. The effectiveness of ERP has been assessed by clinical outcome measures. The patient experience is often neglected. Methods: The current qualitative study was designed alongside a Randomised Control Trial for patients enrolled in an ERP for liver cancer. The aim of the qualitative study was to conduct a process evaluation. 30 patients were interviewed pre-operatively and 6 week post surgery. Transcripts were analysed using Thematic Content Analysis (Braun & Clarke, 2006) Findings: The patient experience of preparing and recovering from surgery for ERP was different for “Avoiders†(patients who distance themselves from negative feelings) and “Sensitizers†(patients who acknowledge negative emotions). Leventhal’s Self-Regulatory Model was used as a theoretical framework to explain the patient experience and ways in which patient education and psychological support may accentuate the effect of ERP. Discussion: The potential for using a psychometric tool for assessing “readiness for fast track surgery†are discussed.