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General health and state anxiety in patients recovering from colorectal cancer surgery
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Surgery, Skåne University Hospital, Malmö, Sweden.ORCID iD: 0000-0002-1735-9437
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden.ORCID iD: 0000-0002-9300-6422
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0002-1437-5060
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. Vol. 72, no 2, p. 328-338
Keywords [en]
EQ-5D-3L, ERAS, STAI, Colorectal cancer, General health, Nursing practice, State anxiety, Surgery
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mau:diva-15249DOI: 10.1111/jan.12841ISI: 000367947700009PubMedID: 26554384Scopus ID: 2-s2.0-84954027111Local ID: 19857OAI: oai:DiVA.org:mau-15249DiVA, id: diva2:1418770
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-06-17Bibliographically approved
In thesis
1. The process of recovery after colorectal cancer surgery: patients' experiences and factors of influence
Open this publication in new window or tab >>The process of recovery after colorectal cancer surgery: patients' experiences and factors of influence
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
Colorectal cancer, Postoperative recovery, Patients' experiences, Factors of influence, Health, Anxiety, Svensson's method, Phenomenology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-7322 (URN)21587 (Local ID)978-91-7104-756-4 (ISBN)978-91-7104-757-1 (ISBN)21587 (Archive number)21587 (OAI)
Note

Paper III and IV in dissertation as manuscripts.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-16Bibliographically approved

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Jakobsson, JennyIdvall, EwaWann-Hansson, Christine

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