Abstract
To meet patients’ information and communication needs over time in order to improve their recovery is particularly challenging for patients undergoing cancer surgery. The aim of the study was to evaluate whether an intervention with a person-centred approach to information and communication for patients diagnosed with colorectal cancer undergoing surgery can improve the patients’ preparedness for surgery, discharge and recovery during six months following diagnosis and initial treatment. The intervention components involving a novel written interactive patient education material and person-centred communication was based on critical analysis of conventional information and communication for these patients. During 2014–2016, 488 consecutive patients undergoing elective surgery for colorectal cancer were enrolled in a quasi-experimental longitudinal study. In three hospitals, first a conventional care group (n = 250) was recruited, then the intervention was introduced, and finally the intervention group was recruited (n = 238). Patients’ trajectories of preparedness for surgery and recovery (Preparedness for Colorectal Cancer Surgery Questionnaire—PCSQ) health related quality of life (EORTC QLQ-C30) and distress (NCCS Distress Thermometer) were evaluated based on self-reported data at five time points, from pre-surgery to 6 months. Length of hospital stay and patients’ behavior in seeking health care pre- and post-surgery were extracted from patient records. Longitudinal structural equation models were used to test the hypothesized effects over time. Statistically significant positive effects were detected for two of the four PCSQ domains (patients searching for and making use of information, and making sense of the recovery) and for the role functioning domain of the EORTC QLQ-C30. Patients in the intervention group were also more likely to contact their assigned cancer “contact nurse” (a.k.a. nurse navigator) instead of contacting a nurse on duty at the ward or visiting the emergency department. In conclusion, the overall hypothesis was not confirmed. Further research is recommended on written and oral support tools to facilitate person-centred communication.
Highlights
Person-centeredness is an emerging perspective in health care to acknowledge who the person in need of care is [1] and is increasingly considered a desired feature both as means for tailoring care to the individual’s needs and specific problems as well as the individual’s recourses and capacity to make sense of and handle challenges related to illness, treatments and care
This study focuses on the effectiveness of a clinical person-centred information and communication intervention to enhance patients’ preparedness for surgery and the recovery following colorectal cancer (CRC) surgery; which is one of the most common types of cancer worldwide affecting both men and women with a decreasing but still high mortality risk, with surgery being the primary treatment [3]
The control and intervention groups were similar with regard to demographic, diagnostic and treatment variables, with one exception; laparoscopic surgery was more frequent in the intervention group than in the control group (Table 1)
Summary
Person-centeredness is an emerging perspective in health care to acknowledge who the person in need of care is [1] and is increasingly considered a desired feature both as means for tailoring care to the individual’s needs and specific problems as well as the individual’s recourses and capacity to make sense of and handle challenges related to illness, treatments and care. Person-centeredness could be positioned in the hermeneutics of self; the person being both suffering and capable [4, 5], and taking an ethical stance to the provision of care [6, 7] This implies that the patient might become distressed when undergoing cancer treatment and has resources to be prepared for understanding and responding to what is to come–if receiving appropriate support. Person-centred communication in healthcare involves dimensions of health literacy [11] Such enabling of the patient’s seeking for knowledge and learning [8] could be conceptualized as a transformation of experience [12]. Person-centred communication is considered a complex intervention involving ways information is communicated [14, 15], both verbally and in writing, for example in patient education materials (PEM) [11]
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