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The process of recovery after colorectal cancer surgery: patients' experiences and factors of influence
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0002-1735-9437
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe and compare how patients recovering from different forms of colorectal cancer surgery experience their postopera-tive recovery, general health, and anxiety, up to six months after surgery. In addition, the aim was to describe the influence of patient- and surgery-related factors on patient-reported recovery. Data was collected through questionnaires containing instruments measuring general health, trait and state anxiety, and recovery. Recruitment was made consecutively. In total, 176 patients chose to participate and received the questionnaires before surgery, on the day of discharge, and one and six months after surgery. In addition, information concerning patient character-istics and factors related to surgery were retrieved from the patients’ medical journals. Data was also collected through in-depth interviews one and six months after surgery with ten purposefully included patients. Postoperative recovery after colorectal cancer surgery was described as a pro-gressive process. Experiences of physical powerlessness, difficulties with food intake, altered bowel function, and dependence on others, were prominent and changed from being intense in the beginning of the process to gradually disappearing as time went by. On the day of discharge, no patient was considered fully recovered or almost fully recovered. Thereafter, it could be seen that patients after colonic resec-tion improved regarding the majority of symptoms connected to recovery al-ready during the first month after surgery, while patients after abdominoper-ineal resection deteriorated somewhat. Patients after rectal resection recovered better during the first month than those after an abdominoperineal resection but not as well as patients after colonic resection. Health was shown to be generally good preoperatively. One month after surgery, patients recovering from abdominoperineal resection and rectal resection had a temporary reduc-tion in health, while patients after a colonic resection had improved. Six months after surgery, health had improved to better than preoperative values without any differences between groups of patients. Regarding anxiety, both as a trait and as a state, this was shown to be low, without any differences between groups. Once at home from hospital, the patients experienced a continued difficulty with food intake, and the physical powerlessness made them initially de-pendent on relatives or friends in order to manage everyday life. The bowel function as well as the practical management of a possible stoma caused feel-ings of insecurity and concern. During the period from one month to six months after surgery, improvements were seen in symptoms connected to re-covery for all patients and especially after abdominoperineal resection. How-ever, it was also clear that patients after a rectal resection had not recovered to the same extent as those after an abdominoperineal or colonic resection. Some factors related to patient characteristics and surgery were shown to be associated with the odds for a good recovery one and six months after sur-gery. Those factors were age, grade of ASA, EQ VAS, EQ index, BMI, dura-tion of surgery, APR procedure, presence of stoma, LoS, and postoperative treatment. In addition, the dimensional levels of recovery could to a great ex-tent predict recovery in corresponding dimensions. The result of this thesis showed a diverse pattern of recovery. Nevertheless, there were also some similarities. This illustrates the complexity of postoper-ative recovery. In order to avoid unnecessary concerns, it is important for health care professionals to provide the patients with appropriate infor-mation and support throughout the whole recovery period and to design in-dividual follow-up strategies.

Place, publisher, year, edition, pages
Malmö högskola, Fakulteten för hälsa och samhälle , 2017. , p. 93
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 2017:1
Keywords [en]
Colorectal cancer, Postoperative recovery, Patients' experiences, Factors of influence, Health, Anxiety, Svensson's method, Phenomenology
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mau:diva-7322Local ID: 21587ISBN: 978-91-7104-756-4 (print)ISBN: 978-91-7104-757-1 (print)OAI: oai:DiVA.org:mau-7322DiVA, id: diva2:1404236
Note

Paper III and IV in dissertation as manuscripts.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-16Bibliographically approved
List of papers
1. Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study
Open this publication in new window or tab >>Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study
2014 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 29, no 8, p. 989-998Article in journal (Refereed)
Abstract [sv]

Syfte: Konceptet enhanced recovery after surgery (ERAS) är en modern vårdregim och många studier har bekräftat dess positiva inverkan på återhämtningen efter kolorektal kirurgi. Det finns dock sparsamt med kunskap om patienternas fortsatta återhämtning efter utskrivning. Därav var syftet med denna studie att beskriva patientrapporterad återhämtning efter kolorektal cancerkirurgi enligt ERAS från utskrivningsdagen till 1 och 6 månader efter kirurgi. Metod: Mätningar gjordes vid utskrivning, efter 1 månad och sex månader efter operation med hjälp av frågeformuläret Postoperative Recovery Profile (PRP). Totalt 119 patienter vilka opererats med rektumamputation, rektumresektion och kolonresektion svarade vid alla tre mättillfälle. Resultat: Global Score of Recovery visade att inga patienter upplevde sig som helt återhämtade vid utskrivning. Efter rektumresektion upplevde många sig som inte alls återhämtad. En månad efter kirurgi rapporterade patienter som återhämtade sig efter kolonresektion signifikanta förbättringar i 11 av 17 item samtidigt som patienter efter rektumamputation inte visade någon signifikant förbättring. Istället visades högre nivåer av problem gällande item som fatigue, muskelsvaghet och nedstämdhet. Rektumresektioner rapporterade signifikanta förbättringar mellan 1 och 6 månader efter kirurgi gällande 7 av 19 item. Dock urskiljde sig det item som handlade om gastrointestinal funktion då patienterna upplevde en signifikant försämring vid 6 månader efter operation. Sammanfattning: Denna studie belyser skillnaderna mellan olika grupper av patienter och skillnaderna i deras återhämtning. Detta visar på olika behov av stöd efter utskrivning.

Abstract [en]

Purpose: The concept of enhanced recovery after surgery (ERAS) is a modern regime of care, and numerous studies have proved its beneficial impact on recovery after colorectal surgery. However, little is known about patients’ continuing recovery after discharge. Therefore, the purpose of this study was to describe patient-reported recovery after colorectal cancer surgery in the context of ERAS from the day of discharge until one month and six months after surgery. Method: Assessments were made at discharge, at one month, and at six months after surgery using the questionnaire Postoperative Recovery Profile (PRP). In all, 119 patients recovering from abdominoperineal resection, rectal resection, or colonic resection completed all three assessments. Results: The global score of recovery showed that no patient experienced being fully recovered at discharge. After rectal resection, patients frequently reported being not at all recovered. One month after surgery, patients recovering from colonic resection reported significant improvements regarding 11 of 17 questionnaire items, whereas abdominoperineal resection patients reported no significant improvements regarding any item. Instead, significantly higher levels of problems were reported in the items fatigue, muscle weakness, and feeling down. Rectal resection patients reported significant improvements between one and six months after surgery regarding 7 of 19 items. However, the item gastrointestinal function distinguished, as patients reported significant deterioration towards higher levels of problems six months after surgery. Conclusion: This study elucidates the difference between groups of colorectal patients and the diverse patterns of their recovery, implying different needs in terms of prolonged support after discharge.

Place, publisher, year, edition, pages
Springer, 2014
Keywords
Postoperative recovery, PRP, Colorectal surgery, ERAS
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-14647 (URN)10.1007/s00384-014-1939-2 (DOI)000339813400013 ()24990352 (PubMedID)2-s2.0-84904697805 (Scopus ID)17656 (Local ID)17656 (Archive number)17656 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
2. General health and state anxiety in patients recovering from colorectal cancer surgery
Open this publication in new window or tab >>General health and state anxiety in patients recovering from colorectal cancer surgery
2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 2, p. 328-338Article in journal (Refereed) Published
Abstract [en]

AIM: To describe and compare general health and state anxiety before surgery and up to 6 months after surgery in patients with colorectal cancer undergoing elective rectal resection, abdominoperineal resection or colonic resection in an enhanced recovery context. BACKGROUND: Little is known about patient-reported health and anxiety after colorectal cancer surgery in an enhanced recovery context. DESIGN: A prospective cohort study. METHODS: Data were collected from October 2011-February 2013. The questionnaires - EuroQol 5-Dimensions 3-Levels and State-Trait Anxiety Inventory - were answered before surgery, at discharge and 1 and 6 months after surgery. Data were analysed using inferential statistics to describe differences between groups of patients (Kruskal-Wallis test) and between assessments within groups (Friedman's anova). RESULTS: Patients (N = 105), divided into three groups based on surgical procedure, showed a high health index and a low state anxiety in all assessments without differences between the groups. Patients considered for abdominoperineal resection rated their pre-operative health as significantly higher than patients after rectal and colonic resections did. Within groups, patients recovering from abdominoperineal resection and rectal resection deteriorated significantly in health index 1 month after surgery. However, after 6 months they had improved again. After colonic resection, patients improved significantly in self-rated health and anxiety 1 month after surgery with no further discernible improvement after 6 months. CONCLUSION: The study showed that patients generally had a high level of health and a low level of anxiety throughout the study period. Only a few differences occurred between assessments within groups.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
EQ-5D-3L, ERAS, STAI, Colorectal cancer, General health, Nursing practice, State anxiety, Surgery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-15249 (URN)10.1111/jan.12841 (DOI)000367947700009 ()26554384 (PubMedID)2-s2.0-84954027111 (Scopus ID)19857 (Local ID)19857 (Archive number)19857 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
3. The lived experience of recovery during the first 6 months after colorectal cancer surgery
Open this publication in new window or tab >>The lived experience of recovery during the first 6 months after colorectal cancer surgery
2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4498-4505Article in journal (Refereed)
Abstract [en]

AIMS AND OBJECTIVES: To describe the lived experience of recovery during the first 6 months after colorectal cancer surgery. BACKGROUND: Colorectal cancer is the third most common cancer diagnosis worldwide. Early discharge places demands on healthcare professionals to prepare patients for their return home and to provide them with appropriate support throughout the recovery process. This requires knowledge of what it is like to recover from colorectal cancer surgery. DESIGN: A qualitative phenomenological design was used to describe the structure of recovery after colorectal cancer surgery. METHODS: Ten patients recovering from colorectal cancer surgery were interviewed at one month and six months after surgery. The descriptive phenomenological method by Giorgi was used throughout the study. RESULTS: Postoperative recovery was described as a progressive process. This process was accompanied by experiences of physical powerlessness, difficulties with food intake, altered bowel function and dependency on others. The experiences were most intense at the beginning of the recovery but disappeared as time went by and normality in life returned. CONCLUSION: While recovering from colorectal cancer surgery, patients experience obstacles that impede their ability to live life as normal. Six months after surgery, those experiences disappear or become adjusted to being part of normal life. RELEVANCE TO CLINICAL PRACTICE: Patients should be provided with information about the expected postoperative recovery before discharge from hospital. The need for professional support appears to be most frequently needed in early recovery, but it should be considered on an individual basis.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-4499 (URN)10.1111/jocn.13780 (DOI)000416319600062 ()28231628 (PubMedID)2-s2.0-85018742018 (Scopus ID)22628 (Local ID)22628 (Archive number)22628 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
4. Patient characteristics and surgery-related factors associated with patient-reported recovery at 1 and 6 months after colorectal cancer surgery
Open this publication in new window or tab >>Patient characteristics and surgery-related factors associated with patient-reported recovery at 1 and 6 months after colorectal cancer surgery
2017 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 26, no 6, article id e12715Article in journal (Refereed)
Abstract [en]

Predictors for postoperative recovery after colorectal cancer surgery are usually investigated in relation to length of stay (LoS), readmission, or 30-day morbidity. This study describes patient characteristics and surgery-related factors associated with patient-reported recovery 1 and 6 months after surgery. In total, 153 consecutively included patients who were recovering from colorectal cancer surgery reported their level of recovery using the Postoperative Recovery Profile. Multiple logistic regression analysis was used to calculate associations with recovery, defined as good or poor, divided into five recovery dimensions: physical symptoms, physical functions, psychological, social and activity. Better preoperative health predicted good recovery regarding three dimensions 1 month after surgery. Regarding all dimensions 1 month after surgery, poor recovery was predicted by a poor recovery on the day of discharge within corresponding dimensions. Higher age was associated with good recovery 6 months after surgery, while chemotherapy showed negative associations. Overall, a majority of factors had a negative impact on recovery, but without any obvious relation to one specific dimension or point in time. Those factors were: high Body Mass Index, comorbidity, abdominoperineal resection, loop ileostomy, colostomy and LoS. This study illustrates the complexity of postoperative recovery and a need for individualised follow-up strategies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-4916 (URN)10.1111/ecc.12715 (DOI)000414613000063 ()28523723 (PubMedID)2-s2.0-85019389290 (Scopus ID)22627 (Local ID)22627 (Archive number)22627 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved

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Jakobsson, Jenny

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