What's going on after hospital? - Exploring the transition from hospital to home and patient experiences of nurse-led follow-up phone calls

SCAPAS-LungCancer-improving supportive care for patients surgically treated for non-small cell lung cancer: protocol for a prospective, longitudinal, observational and exploratory multicentre study

INTRODUCTION AND AIM

Despite global advances in lung cancer treatment, challenges persist in symptom management and supportive care, particularly as the incidence of early-stage diagnoses rises. Patients with non-small cell lung cancer (NSCLC) face symptom burdens compounded by physical, psychological and social factors, alongside the concealment of early-stage symptoms. Research on symptom management in patients with NSCLC remains limited, with a lack of studies exploring patient experiences and clinical management strategies. Moreover, attention to late effects highlights the need for personalised care interventions to address long-term outcomes. The SCAPAS-LungCancer study aims to bridge these gaps by enhancing our understanding of NSCLC symptomatology, late effects and quality of life. The study seeks to identify patients with multiple symptoms and late effects, offering insights for future personalised care interventions to improve patient outcomes and overall well-being.

METHODS AND ANALYSIS

The study employs a multiple-methods approach encompassing qualitative and quantitative investigations to comprehensively explore symptomatology, patient experiences and treatment outcomes in patients with NSCLC undergoing surgical treatment. A prospective, longitudinal, observational and exploratory design is adopted. A longitudinal qualitative study, including individual interviews and ethnographic fieldwork, will be conducted to explore patients' experiences and interactions with clinicians on symptoms and late effects. Additionally, consecutive newly diagnosed patients with NSCLC scheduled for surgery will be recruited in a prospective questionnaire study using patient-reported outcomes. Eligible patients will complete self-reported measures assessing physical and psychosocial symptom burden and late effects, quality of life, social support and unmet needs at baseline and multiple follow-up points post-surgery over a 2-year period. Socio-demographic and medical characteristics are also collected.

ETHICS AND DISSEMINATION

The study is approved by the Danish Data Protection Agency (journal no: 2022-737) and conducted in accordance with Danish Ethics Research Committee guidelines and the Helsinki II Declaration. Participants will provide written informed consent. The results will be reported in peer-reviewed journals.

What they did next: Using follow-up phone calls to investigate health care access patterns of patients who take their own leave

OBJECTIVES

The purpose of the present study was to use telephone follow-up (TFU) to investigate the actions taken by patients after they took their own leave (TOL) from an ED, with a focus on priority groups who are at risk of experiencing health inequity. These included people experiencing homelessness (EH), people with a low socioeconomic status by index of relative socioeconomic disadvantage (IRSD) and First Nations people. The primary outcome was being seen by a general practitioner (GP) within 2 days of the TOL event. The utility of the TFU was also examined.

METHODS

This was an observational study of data collected during a quality improvement intervention at an inner-city, tertiary, teaching hospital in Melbourne from January to December 2022. Descriptive results were obtained from a TFU survey that was administered 24-48 h after the TOL event.

RESULTS

During the study period, 4209 patients TOL from the ED. Eight hundred forty-one of these were contacted and consented to the TFU survey. 97.7% of patients expressed gratitude at being followed up. Patients EH, compared to patients not EH, were less likely to have seen their GP within 2 days of TOL event (0.295 [0.132-0.661], P < 0.001). Both First Nations patients and those from low IRSD areas were as likely to have seen their GP within 2 days as other groups.

CONCLUSION

Patients EH were less likely to receive GP care within 2 days of TOL. Improving the access and acceptability of health care in these priority groups is important for achieving health equity.

Optimizing nurse staffing in thoracic surgery: the imperative of Enhanced Recovery Programs-a statement of the European Society of Thoracic Surgeons Nursing & Allied Health Professionals Working Group

Enhanced Recovery Programs (ERPs) have revolutionized thoracic surgery by reducing hospital stays and fostering quicker patient recoveries through minimally invasive procedures. However, the perception that patients in ERPs are less complex and require fewer nursing resources is misleading. Despite shorter hospital stays, the complexity of postoperative care remains high, with patients often needing vigilant monitoring and timely interventions. This article challenges the assumption of reduced nursing needs in ERPs, arguing that the fast-paced nature of these programmes intensifies the demand for skilled nursing care. The European Society of Thoracic Surgeons (ESTS) Nurses & Allied Health Professionals Working Group emphasizes that nurse staffing levels must be maintained or even increased to ensure quality care in ERPs. Adequate staffing is crucial for supporting not only the technical aspects of care but also the patient's experience of illness and recovery. Failure to recognize this complexity could compromise patient outcomes, eroding the benefits of ERPs. This paper advocates for a comprehensive approach that balances efficiency with sufficient nursing support to optimize outcomes in thoracic surgery ERPs. It calls for a reassessment of staffing models to meet the evolving demands of these programmes, ensuring that the advantages of shorter recovery times are not undermined by insufficient care.

Ready to Go Home? Nurses' Perspectives of Prolonged Admission for Patients Undergoing Video-Assisted Thoracic Surgery for Non-Small-Cell Lung Cancer in Denmark

Enhanced recovery after surgery programs with median postoperative hospitalization of 2 days improve outcomes after lung cancer surgery. This article explores nursing care practices for patients with lung cancer who remain hospitalized despite having recovered somatically. Qualitative focus group interviews were conducted with 16 nurses. Ricoeur's phenomenological hermeneutics underpins the methodology applied in this study, and we relied on Benner and Wrubel's theory. The nurses emphasized that the thoughts of patients with a recent lung cancer diagnosis revolve around more than the surgery. Nursing comprises not only practicalities but also attending to patients' stress and their coping with being struck with lung cancer and having undergone surgery. A counterculture emerged to counteract the logic of productivity, indicating that caring as a worthy end in itself may be underestimated in protocol-driven care. Prolonging hospitalization largely depends on clinical judgment. The nurses' aim is not to keep patients in the hospital but to avoid any needless suffering, allowing them to reclaim the primacy of caring.

Patient-Reported Outcome and Experience Measures (PROM/PREM) in Patients Undergoing Liver Surgery with Enhanced Recovery after Surgery (ERAS®): An Exploratory Study

BACKGROUND

ERAS® (Enhanced Recovery after Surgery) is an evidence-based multidisciplinary approach focusing on optimizing outcomes after surgery through structured clinical pathways. This study aimed to assess patient-reported outcome and experience measures (PROM/PREM), which are not routinely assessed after liver surgery within an ERAS® protocol.

METHODS

Routine outcome parameters were extracted from clinical documentation. Using qualitative content analysis, PROM and PREM were retrospectively identified in 13 case records. In a prospective survey of 10 participants, PROM was assessed at three timepoints using the EQ-5D-5L questionnaire. PREM were collected at discharge.

RESULTS

The following PROM categories occurred in the retrospective content analysis: appetite (84.6%), pain/discomfort (76.9%), mobility (69.2%), wound condition (69.2%), and weight (61.5%). The categories of continuity of care (92.0%) and information, communication, education (69.0%) emerged as PREM. Descriptive changes in health state were shown for all EQ-5D-5L dimensions and timepoints. At discharge, mobility, selfcare, usual activities, and pain/discomfort tended to be worse, whereas anxiety/depression decreased gradually from preoperatively to the 4 week follow-up. There was high satisfaction with interprofessional care services and experienced cooperation between professionals.

CONCLUSIONS

PROM and PREM are helpful to incorporate patients' perspectives after liver surgery within an ERAS® pathway and should be collected routinely in clinical practice.

Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery: A qualitative study

BACKGROUND

Closed-incision negative pressure therapy may lower the risk of surgical site infections in patients after peripheral arterial surgery.

AIM

To explore patient experience of negative pressure therapy applied to groin incisions after discharge following peripheral arterial surgery, and to study their perception and attitudes toward the self-care information sheet they received at the vascular department.

METHODS

A qualitative study underpinned by Gadamer's philosophical hermeneutics was conducted semi-structured interviews by telephone around day seven after therapy ended with ten participants. All had received self-care information sheet at the discharge and been home with closed-incision negative pressure therapy for 3-6 days. The participants had open peripheral arterial surgery in the groin in form of femoral thromboendarterectomy. Kvale and Brinkmann's research guided the data collection, analysis, and interpretation.

FINDINGS

Patients found themselves coping with an unfamiliar situation after peripheral arterial surgery and the need arose to conceal the pump and tubing that were part of their incision treatment to protect their self-image. Their treatment became a constant companion, with some patients viewing the equipment as an extension of their bodies and others feeling its impact on activities of daily living. Patients perceived the treatment as providing reassurance, albeit with constraints, leading to feelings of manageability and an increasing sense of control. They viewed the written information as informative but with room for improvement.

CONCLUSIONS

Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery showed that they perceived it as safe and manageable. Patients need support, however, in learning how to hide the treatment and to expand their own involvement and improve self-care. The study found that patient involvement and individually tailored information is essential to facilitating a healthy transition from hospital to self-care at home and that written information must be improved further.

User-acceptability of an automated telephone call for post-operative follow-up after uncomplicated cataract surgery

BACKGROUND

Innovative technology is recommended to address the current capacity challenges facing the NHS. This study evaluates the patient acceptability of automated telephone follow-up after routine cataract surgery using Dora (Ufonia Limited, Oxford, United Kingdom), which to our knowledge is the first AI-powered clinical assistant to be used in the NHS. Dora has a natural-language, phone conversation with patients about their symptoms after cataract surgery.

METHODS

This is a prospective mixed-methods cohort study that was conducted at Buckinghamshire Healthcare NHS Foundation Trust. All patients who were followed up using Dora were asked to give a Net Promoter Score (NPS), and 24 patients were randomly selected to complete the validated Telephone Usability Questionnaire (TUQ) as well as extended semi-structured interviews that underwent thematic analysis.

RESULTS

A total of 170 autonomous calls were completed. The median NPS score was 9 out of 10. The TUQ (scored out of 5) showed high rates of acceptability, with an overall mean score of 4.0. Simplicity, time saving, and ease of use scored the highest with a median of 5, whilst 'speaking to Dora feels the same as speaking to a clinician' scored a median of 3. The main themes extracted from the qualitative data were 'I can see why you're doing it', 'It went quite well actually', 'I just trust human beings I suppose'.

CONCLUSION

We found high levels of patient acceptability when using Dora across three acceptability measures. Dora provides a potential solution to reduce pressure on hospital capacity whilst also providing a convenient service for patients.

Issues in patients' experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

OBJECTIVE

To explore patients' experiences of enhanced recovery after surgery (ERAS) and to identify issues in the implementation of ERAS from the patient's perspective.

DESIGN

The systematic review and qualitative analysis were based on the Joanna Briggs Institute's methodology for conducting synthesis.

DATA SOURCES

Relevant studies published in four databases, that is, Web of Science, PubMed, Ovid Embase and the Cochrane Library, were systematically searched, and some studies were supplemented by key authors and reference lists.

STUDY SELECTION

Thirty-one studies were identified, involving 1069 surgical patients enrolled in the ERAS programme. The inclusion and exclusion criteria were formulated based on the Population, Interest of phenomena, Context, Study design criteria recommended by the Joanna Briggs Institute to determine the scope of article retrieval. The inclusion criteria were as follows: ERAS patients' experiences; qualitative data; English language and published from January 1990 to August 2021.

DATA EXTRACTION

Data were extracted from relevant studies using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument for qualitative research.

DATA SYNTHESIS

The themes in the structure dimension are as follows: (1) patients cared about the timeliness of healthcare professionals' help; (2) patients cared about the professionalism of family care; and (3) patients misunderstood and worried about the safety of ERAS. The themes in the process dimension are as follows: (1) patients needed adequate and accurate information from healthcare professionals; (2) patients needed to communicate adequately with healthcare professionals; (3) patients hoped to develop a personalised treatment plan and (4) patients required ongoing follow-up services. The theme in the outcome dimension is as follows: patients wanted to effectively improve severe postoperative symptoms.

CONCLUSIONS

Evaluating ERAS from the patient's perspective can reveal the omissions and deficiencies of healthcare professionals in clinical care so that problems in patients' recovery process can be solved in a timely manner, reducing potential barriers to the implementation of ERAS.

PROSPERO REGISTRATION NUMBER

CRD42021278631.

'My biggest fear is that people will forget about him': Mothers' emotional transitions after terminating their pregnancy for medical reasons

AIMS AND OBJECTIVES

To explore women's emotional responses throughout the process of terminating a pregnancy for medical reasons.

BACKGROUND

Making the choice to terminate a desired pregnancy for medical reasons has a negative impact on women's health, as it is a distressing process that involves making hard decisions and readjusting one's expectations of an idealised pregnancy.

METHODS

A qualitative phenomenological study was conducted following the COREQ checklist. Fifteen semi-structured interviews and two focus groups were conducted with women who had terminated their pregnancies for medical reasons, previous to and during the COVID-19 lockdown. Subsequently, we analysed the content.

RESULTS

One main category, emotional journey during the process of terminating the pregnancy, and six subcategories were identified: (I) representation and desire to become a mother, (II) main concerns, (III) impact of the news, (IV) decision-making, (V) emotional responses before termination for medical reasons and (VI) emotional responses after termination for medical reasons. All contributed to understanding the specificities of the different phases that make up the emotional journey of terminating a pregnancy for medical reasons.

CONCLUSIONS

The findings of this study suggest that there are a number of predominant emotions that professionals need to be aware of in order to help women work through them and lessen the impact of pregnancy termination on their mental health. COVID-19 had different connotations depending on the women's experiences.

RELEVANCE TO CLINICAL PRACTICE

Our results highlight how important the role of healthcare staff is in caring for these women and their partners, which involves recognising their emotions throughout the process. Our results also underline how useful it is to conduct qualitative studies in this context, since they constitute a set of activities and interventions that result in the administration of nursing care in itself.

PATIENT OR PUBLIC CONTRIBUTION

The ultimate goal of the action research study is to design a positive mental health intervention. Participants will contribute to the design and final approval of the intervention.

Towards reduction of preventable hospital readmission: Older people and family members' views on planned self-management of care at home

AIMS AND OBJECTIVES

To reduce the likelihood of preventable readmissions, the aim was to investigate how older people (with their family members) managed their chronic health conditions at home following hospital discharge. The objectives explored older people and their family members' perspectives on how discharge plans assisted self-management of their chronic conditions, their recognition of deterioration and when to seek treatment/re-attend hospital.

BACKGROUND

Chronic conditions have challenged older adults' self-management, particularly after hospital discharge and can impact on preventable readmission. Few studies have examined patients' and their family members' perspectives on the management of their conditions at home after hospitalisation.

DESIGN

A qualitative exploratory design known as Interpretive Description was utilised.

METHODS

Purposeful sampling involved 27 community-dwelling older adults; nineteen were discharged patients with one or more chronic health conditions. Eight nominated family members were also recruited to enhance understanding of the older persons' self-management at home. Interviews were undertaken and thematic data analysis followed the COREQ guidelines.

RESULTS

Five themes emerged: (1) Post-Discharge Advice; (2) Managing at Home; (3) Recognition and Response to Deterioration; (4) Community Care and Support; and (5) The "Burden" on Others of Post-Discharge Care.

CONCLUSION

Older people sought a clear plan for self-management at home prior to discharge. This plan should contain potential signs of deterioration and guidance on future action. We found that support given to older people from family and friends was critical to prevent readmission. In addition, their local General Practitioner and Pharmacist played an essential part in the support of their care. For some, social support services were also important. Nurse telephone follow-up in the week following discharge was mostly absent. However, this strategy would be strongly recommended.

RELEVANCE TO CLINICAL PRACTICE

To mitigate against preventable readmission, we recommend the above strategies to assist the older person at home with self-management of their chronic conditions.

Framework, component, and implementation of enhanced recovery pathways

The introduction of enhanced recovery pathways (ERPs) has led to a considerable paradigm shift towards evidence-based, multidisciplinary perioperative care. Such pathways are now widely implemented in a variety of surgical specialties, with largely positive results. In this narrative review, we summarize the principles, components and implementation of ERPs, focusing on recent developments in the field. We also discuss ‘special cases’ in ERPs, including: surgery in frail patients; emergency procedures; and patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/COVID-19).