Post-discharge symptoms following fast-track colonic cancer surgery: a phenomenological hermeneutic study

Abstract

ObjectiveTo obtain knowledge of patients’ experiences of postoperative symptoms during the initial two weeks following fast-track colonic cancer surgery.MethodSemi-structured in-depth interviews with seven colonic cancer patients two weeks post hospital discharge. Analysis was performed using a phenomenological hermeneutical approach.ResultsDuring the first two weeks after discharge the patients experienced unfamiliar symptoms that affected their everyday lives. Despite distressing symptoms, they applied a “wait-and-see” strategy, and only reacted when symptoms became intolerable. The patients failed to report their unfamiliar symptoms during hospital nurse follow-up telephone call. While waiting for the final histology patients suffered loss of sleep and chaotic thinking, and experienced ambiguity of hoping for the best and expecting the worst.ConclusionAlthough fast-track surgery programmes lead to shorter hospitalisation and improved physical performance, post-colonic surgery patients experience various symptoms after discharge. Healthcare professionals need to address symptoms that might have immediate and long-term consequences on patients’ everyday life. Follow-up studies are encouraged to explore the patient perspective to identify the needs of individual patients after hospital discharge.

The lived experience of recovery during the first 6 months after colorectal cancer surgery

“…When recovery did not proceed as expected, participants in the study by Beech et al (2012) doubted the validity of their concern due to their lack of experience or knowledge. A strategy of 'wait and see' has been described in studies because participants hesitate to contact healthcare professionals as they believe that their symptoms will eventually disappear or that they are not important enough to warrant contact (Beech et al, 2012;Krogsgaard, Dreyer, Egerod, & Jarden, 2014). It has also been reported that participants do not know what to expect after coming home from hospital, which leads to anxiety and concern (Beaver et Taylor et al, 2010).…”

Lost in transformation? Reviving ethics of care in hospital cultures of evidence‐based healthcare

“…These values are also reflected in the ideals of patient participation and correspond with values of an ethics‐of‐care perspective that emphasizes the specific needs of specifics individuals in specific situations as reflected by important nurse theorists such as (Benner & Wrubel, ; Martinsen & Eriksson, ; Travelbee, ). Empirical studies dealing with patients’ experiences of participating in fast‐track programmes and evidence‐based practices send similar messages (Kovarsky, ; Krogsgaard et al., ; Norlyk & Harder, ; ). No one wants to be a ‘hip replacement’.…”

“…Our previous phenomenological research of patients’ experiences of participating in fast‐track programmes has illustrated a clinical practice dominated by the rationality of scientific evidence (Krogsgaard, Dreyer, Egerod, & Jarden, ; Norlyk & Harder, ; ; Norlyk & Martinsen, ). Drawing on our previous research, we provide an exemplary narrative of how evidence‐based programmes are being practised in Danish hospitals.…”

“…The narrative below develops from an initial naive reading of our previous research (Krogsgaard et al., ; Norlyk & Harder, ; ; Norlyk & Martinsen, ) followed by an interpretation moving from ‘what is said’ in the interviews to what the interviews ‘talk about’. The interpreted meanings of patients’ experiences are presented in the short narrative, which reflects the experiences of a 74‐year‐old woman who has undergone a hip replacement.…”

Regaining familiarity with own body after treatment for operable lung cancer - a qualitative longitudinal exploration

“…Fast-track programmes in Denmark are usually organised with follow-up contact for the patients after discharge (Kehlet 2011;Hjort Jakobsen et al 2014); however, follow-up was not performed for the patients in the present study. Research showed that patients may be hesitant or uncomfortable about asking questions or requesting additional information for fear of taking up too much time, appearing uninformed, feeling that they are a bother, are unaware of available options or because they do not know who to ask for help (Parker & Kreps 2005;Steele & Fitch 2008;Krogsgaard et al 2014). This indicates that follow-up contact in the week following discharge should preferably be the responsibility of health professionals, and may be required for patients after surgical treatment for lung cancer.…”