Managing the Consequences of Oncological Major Surgery: A Short- and Medium-Term Skills Assessment Proposal for Patient and Caregiver through M.A.D.I.T. Methodology.

Gian Piero Turchi,Marta Silvia Dalla Riva,Alessandro Fabbian,Carlo Castoro,Eleonora Pinto,Davide Bassi,Pierluigi Pilati,Rita Alfieri,Anna Da Roit,Luisa Orrù,Genny Mattara,Salvatore Marano

doi:10.3390/bs12030077

Abstract

The effects of cancer surgery and treatment harm patients’ life and working ability: major causes of this can be intensified by the postoperative symptoms. This study, the first part of the HEAGIS project (Health and Employment after Gastrointestinal Surgery), proposes a method to assess patients and caregivers’ competences in dealing with postoperative course and the related needs to improve the adequate competences. In this observational study, an ad hoc structured interview was conducted with 47 patients and 15 caregivers between the third and fifteenth postoperative day. Oesophageal (38%), esophagogastric junction (13%), gastric (30%), colon (8%) and rectum (11%) cancer patients were considered. Computerized textual data analysis methodology was used to identify levels of competences. Text analysis highlighted three different levels (low, medium and high) of four specific types of patients and caregivers’ competences. In particular, the overall trend of the preview of future scenarios and use of resource competences was low. Less critical were situation evaluation and preview repercussion of own actions’ competences. Caregivers’ trends were similar. The Kruskal–Wallis test did not distinguish any differences in the level of competences related to the characteristics of the participants. Patients and caregivers are not accurate in planning the future after surgery, using personal beliefs rather than referring to physicians, and not recognizing adequate resources. The medium-low competences’ trend leads to unexpected critical situations, and patients could not deal with them in a maximally effective way. Both patients and caregivers should be taken over by healthcare professionals to improve patients’ competences and make the curative surgery effective in daily life.

Highlights

Despite the decrease in deaths caused, gastrointestinal (GI) and upper gastrointestinal neoplasms are the most commonly diagnosed tumours and carry a significant burden of symptoms [1,2]
The study we describe here, the beginning part of the main project, shows and comments on the results collected through a tool previously created and tested on a small sample of patients and caregivers [30] to assess the competences of patients and caregivers dealing with the postoperative course after surgery, in patients with oesophageal, gastric and colorectal cancer
Implementing psychological support which works on emotional impacts could be useful, but it is necessary to offer a more specific intervention which can help patients in finding better strategies to overcome new difficulties they will be facing once returned to their home

Summary

Introduction

Despite the decrease in deaths caused, gastrointestinal (GI) and upper gastrointestinal neoplasms are the most commonly diagnosed tumours and carry a significant burden of symptoms [1,2]. These symptoms last even after curative treatments [3]: many studies underline the implications of surgery as elective treatment for GI and upper GI cancer on patients’ health experience [4–6]. Physical implications such as reduced tolerance to energy or activity, heartburn, diarrhoea, constipation, early feeling of fullness after eating and dumping syndrome are considered related to fatigue and worry, anxiety and depression, sleep disturbances and difficulty reconstructing the experience after cancer diagnosis [7–11]. Effects have been observed on survivors’ employment activities, job productivity and personal finances after major surgery [15–17]

Methods

Results

Discussion

Conclusion