Patients’ experiences of enhanced recovery after surgery: a systematic review of qualitative studies

• Published in: Journal of clinical nursing 2017-05, Vol.26 (9-10), p.1172-1188
• Main Authors: Sibbern, Tonje, Bull Sellevold, Vibeke, Steindal, Simen A, Dale, Craig, Watt‐Watson, Judy, Dihle, Alfhild
• Format: Article
• Language: English
• Subjects: Adult; Clinical Protocols; Content analysis; enhanced recovery after surgery; Humans; information; meta‐synthesis; Nursing; pain; Pain Management - nursing; Pain Management - psychology; Pain Measurement; Pain, Postoperative - nursing; Pain, Postoperative - prevention & control; Patient Satisfaction; Patients; patients’ experiences; Postoperative Period; Qualitative Research; qualitative systematic review; Surgery; symptom management; Systematic review
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.13456

Aims and objectives To aggregate, interpret and synthesise findings from qualitative studies to further our knowledge regarding patients’ pre‐ and postoperative experiences when participating in an enhanced recovery after surgery. Background Numerous quantitative studies have documented benefits of participation in enhanced recovery after surgery programmes. Randomised control trials show that enhanced recovery after surgery reduce patient morbidity and shorten hospital length of stay. However, we presently have only sparse knowledge regarding patients’ experiences of participating in these programmes. Design A qualitative systematic review and meta‐synthesis. Methods A systematic literature search of databases (Cinahl, Medline, PsycINFO, Ovid Nursing, and EMBASE) for qualitative studies published between 2000–2014 were undertaken. The identified studies were critically evaluated using the Critical Appraisal Skills Program, and patient experiences were synthesised into new themes by a team of researchers, using qualitative content analysis. Results Eleven studies were included. Upon analysis, four main themes emerged: information transfer, individualised treatment vs. standardised care, balancing burdensome symptoms and expectations for rapid recovery, and sense of security at discharge. Information helped patients feel secure and prepared for surgery. Patients reported being motivated to participate in their recovery process. However, this became challenging when they faced symptoms such as pain, nausea, and weakness. Professional support fostered a feeling of security that was important in helping patients continue their regimen, recover, and be discharged as early as planned. Conclusions Patients in enhanced recovery after surgery programmes desired more consistency between pre‐ and postoperative information. Important opportunities exist to improve symptom management and help patients feel more secure about recovery postoperatively. Relevance to clinical practice Nurses are in a unique position to improve communication of standardised regimens and enhance symptom management across the perioperative period. Clinical outreach, such as follow‐up visits or phone calls, could target older adults who need additional assistance to meet enhanced recovery after surgery programme goals and derive benefit.