Patient Perspectives on Transitions of Surgical Care: Examining the Complexities and Interdependencies of Care

• Published in: Qualitative health research Vol. 27; no. 12; pp. 1856 - 1869
• Main Authors: González, Maynor G., Kelly, Kristin N., Dozier, Ann M., Fleming, Fergal, Monson, John R. T., Becerra, Adan Z., Aquina, Christopher T., Probst, Christian P., Hensley, Bradley J., Sevdalis, Nick, Noyes, Katia
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.10.2017; SAGE PUBLICATIONS, INC
• Subjects: Adult; Anxiety; Anxiety - psychology; Attitude to Health; Colorectal Surgery - psychology; Continuity of Patient Care; Health technology assessment; Humans; Interviews as Topic; Malignant; Patient Discharge; Patient Satisfaction; Patient-centered care; Patients; Psychological distress; Qualitative research; Surgery; Surgical outcomes; Surgical Procedures, Operative - psychology; Transitions; transitions of care; discharge process; surgical outcomes; qualitative methods; complexity science; northeastern US; patient perceptions
• ISSN: 1049-7323; 1552-7557
• DOI: 10.1177/1049732317704406

This study examined a thematic network aimed at identifying experiences that influence patients’ outcomes (e.g., patients’ satisfaction, anxiety, and discharge readiness) in an effort to improve care transitions and reduce patient burden. We drew upon the Sociology and Complexity Science Toolkit to analyze themes derived from 61 semistructured, longitudinal interviews with 20 patients undergoing either a benign or malignant colorectal resection (three interviews per patient over a 30-day after hospital discharge). Thematic interdependencies illustrate how most outcomes of care are significantly influenced by two cascades identified as patients’ medical histories and home circumstances. Patients who reported previous medical or surgical histories also experienced less distress during the discharge process, whereas patients with no prior experiences reported more concerns and greater anxiety. Patient dissatisfactions and challenges were due in large part to the contrasts between hospital and home experiences. Our hybrid approach may inform patient-centered guidelines aimed at improving transitions of care among patients undergoing major surgery.