Abstract
Introduction: Hernias are one of the most common surgical diagnoses, and general surgical operations are performed. The involvement of patients in the decision making can be limited. The aim of this study was to explore the perspectives of patients around their hernia and its management, to aid future planning of hernia services to maximise patient experience, and good outcomes for the patient.Methods: A SurveyMonkey questionnaire was developed by patient advocates with some advice from surgeons. It was promoted on Twitter and Facebook, such as all found “hernia help” groups on these platforms over a 6-week period during the summer of 2020. Demographics, the reasons for seeking a hernia repair, decision making around the choice of surgeon, hospital, mesh type, pre-habilitation, complications, and participation in a hernia registry were collected.Results: In total, 397 questionnaires were completed in the study period. The majority of cases were from English speaking countries. There was a strong request for hernia specialists to perform the surgery, to have detailed knowledge about all aspects of hernia disease and its management, such as no operation and non-mesh options. Chronic pain was the most feared complication. The desire for knowledge about the effect of the hernia and surgery on the sexual function in all age groups was a notable finding. Pre-habilitation and a hernia registry participation were well-supported.Conclusions: Hernia repair is a quality of life surgery. Whether awaiting surgery or having had surgery with a good or bad outcome, patients want information about their condition and treatment, such as the effect on aspects of life, such as sex, and they wish greater involvement in their management decisions. Patients want their surgery by surgeons who can also manage complications of such surgery or recommend further treatment. A large group of “hernia surgery injured” patients feel abandoned by their general surgeon when complications ensue.
Highlights
Hernias are one of the most common surgical diagnoses, and general surgical operations are performed
There is a lack of research or knowledge about what is important or critical to our patients? Two recent studies exploring some of these issues in ventral hernia repair recruited only 22 and 30 patients, respectively, in single centres, making their generalisability less clear cut [4, 5]
The investigators agreed on the main aims of the survey—to investigate expectations of patients from hernia surgery focussing on their priorities throughout the process of hernia surgery—initial motivation for repair, preoperative consultation, operative and follow-up preferences, along with their views about mesh use
Summary
Hernias are one of the most common surgical diagnoses, and general surgical operations are performed. Patient reported outcome measures (PROMs) have gained popularity, but PROMs still only ask questions to patients that the doctor wants to be answered [1] Such questions may not reflect the priorities of the patient, or address elements of the patient experience or barriers to their treatment or what best leads to satisfying outcomes. Such failures in seeking patient focussed data are not unique to hernia surgery [2]. Patient focussed priorities are a key part of the GRADE approach in writing the clinical guidelines [3] It dictates: “to make sensible recommendations guideline panels must consider all outcomes that are important or critical to patients for decision making”. There is a lack of research or knowledge about what is important or critical to our patients? Two recent studies exploring some of these issues in ventral hernia repair recruited only 22 and 30 patients, respectively, in single centres, making their generalisability less clear cut [4, 5]
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