Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study

Abstract

Objectives: 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.

Design: Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach.

Setting: Five tertiary care centres in Alberta, Canada, following the ERAS programme.

Participants: 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.

Results: 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.

Conclusion: 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.

Keywords: Colorectal surgery; Quality in healthcare.

Figure 1

The PaCER (Patient and Community Engagement Research) methodology of Set, Collect, Reflect engages patient-participants as partners throughout the research process.

Figure 2

Patient-defined surgical journey. Patient-participants perceived that, to be a programme focused on enhanced recovery, the Enhanced Recovery After Surgery programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to patient-defined recovery.