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      Exploring the experience of an enhanced recovery programme for gynaecological cancer patients: a qualitative study

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          Abstract

          Background

          Perioperative enhanced recovery programmes (ERPs), identified as initiatives that improve care and save money, have been adopted by NHS Improvement and are currently being rolled out across many surgical departments within the NHS. To date, five papers have specifically explored patients’ experiences of ERPs; none, however, has explored the gynaecological cancer patient experience.

          Methods

          In total, 14 women (mean age, 66 years) participated in an audio-recorded face-to-face or telephone interview in which they discussed their experience of taking part in an ERP. The resulting data were transcribed verbatim and analysed using interpretative phenomenological analysis.

          Results

          Two main themes emerged from the analysis. The first, ‘Taking part in the programme’, highlights two important aspects of the ERP: being given an opportunity to receive information and, following this, to build knowledge about the programme. The theme also explores the challenges associated with the programme, particularly around getting mobile and complying with its demands - the women report experiencing a constant battle between intuition and instruction. The second theme, ‘Home’, focuses on the role home plays in motivating the patients to aim for an early discharge from hospital. Patients describe their need to return to a suitable home and the need for support from others. They also discuss the importance of the follow-up phone call.

          Conclusion

          Overall, the patients in this study positively assessed the individual aspects of the ERP, in particular, information resources, the availability of the physiotherapist and the delivery of follow-up phone calls. These findings highlight the importance of developing and maintaining individual aspects of ERPs over time, to ensure their sensitivity and responsiveness to patient needs.

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          Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory.

          Helene Starks, Susan Brown Trinidad (2007)
          The purpose of this article is to compare three qualitative approaches that can be used in health research: phenomenology, discourse analysis, and grounded theory. The authors include a model that summarizes similarities and differences among the approaches, with attention to their historical development, goals, methods, audience, and products. They then illustrate how these approaches differ by applying them to the same data set. The goal in phenomenology is to study how people make meaning of their lived experience; discourse analysis examines how language is used to accomplish personal, social, and political projects; and grounded theory develops explanatory theories of basic social processes studied in context. The authors argue that by familiarizing themselves with the origins and details of these approaches, researchers can make better matches between their research question(s) and the goals and products of the study.
          Article 0 comments Cited 359 times – based on 0 reviews     Review now
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            Supporting autonomy to motivate patients with diabetes for glucose control.

            Edward L Deci, Jason G. Williams, Scott R. Freedman (1998)
            We applied the self-determination theory of human motivation to examine whether patient perceptions of autonomy supportiveness (i.e., patient centeredness) from their diabetes care providers related to improved glucose control over a 12-month period. We conducted a prospective cohort study of patients with diabetes from a diabetes treatment center at a university-affiliated community hospital. Participants were 128 patients between 18 and 80 years of age who took medication for diabetes, had no other major medical illnesses, and were responsible for monitoring their glucose and taking their medications. The main outcome measure was a change in HbA1c values over the 12 months of the study Patient perception of autonomy support from a health care provider related to a change in HbA1c values at 12 months (P < 0.05). Further analyses showed that perceived autonomy support from the staff related to significant increases in patient autonomous motivation at 12 months (P < 0.05); that increases in autonomous motivation related to significant increases in perceived competence (P < 0.05); and that increases in a patient's perceived competence related to significant reductions in their HbA1c values over 12 months (P < 0.001). The findings support the prediction of the self-determination theory that patients with diabetes whose health care providers are autonomy supportive will become more motivated to regulate their glucose levels, feel more able to regulate their glucose, and show improvements in their HbA1c values.
            Article 0 comments Cited 136 times – based on 0 reviews     Review now
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              Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper.

              Antony Arthur, Mark Avis, Ya-Ling Lee (2008)
              Only a fifth of older people undertake a level of physical activity sufficient to lead to health benefit. Misconceptions about the ageing process and beliefs about the costs and benefits of exercise in late life may result in unnecessary self-imposed activity restriction. Thus, adhering to a physical activity can be difficult particularly when the benefits of exercise are often not immediate. Many of the barriers to engaging in physical activity among older people are attitudinal. It is therefore important to take account of the non-physical aspects of physical activity intervention programmes, such as increasing confidence. Self-efficacy is a widely applied theory used to understand health behaviour and facilitate behavioural modification, such as the increase of physical activity. This paper aims to examine the ways in which self-efficacy theory might be used in intervention programmes designed to overcome psychological barriers for increasing physical activity among older people. A number of studies have demonstrated that exercise self-efficacy is strongly associated with the amount of physical activity undertaken. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of a physical activity intervention is beneficial. Physical activity interventions aimed at improving the self perception of exercise self-efficacy can have positive effects on confidence and the ability to initiate and maintain physical activity behaviour. There are a number of ways for nurses to facilitate older people to draw on the four information sources of self-efficacy: performance accomplishments, vicarious learning, verbal encouragement, and physiological and affective states. Research challenges that future studies need to address include the generalisability of exercise setting, the role of age as an effect modifier, and the need for more explicit reporting of how self-efficacy is operationalised in interventions.
              Article 0 comments Cited 79 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Stephanie Archer
                Jane Montague
                Anish Bali
                Journal
                Journal ID (nlm-ta): Perioper Med (Lond)
                Journal ID (iso-abbrev): Perioper Med (Lond)
                Title: Perioperative Medicine
                Publisher: BioMed Central
                ISSN (Electronic): 2047-0525
                Publication date Collection: 2014
                Publication date (Electronic): 4 April 2014
                Volume: 3
                Page: 2
                Affiliations
                [1 ]Psychology Department, Faculty of Education, Health & Science, University of Derby, Kedleston Road, Derby DE22 1GB, UK
                [2 ]Centre for Patient Safety and Service Quality, Imperial College London, Medical School Building, St Mary’s Campus, Norfolk Place, London W2 1PG, UK
                [3 ]Gynaecology/Oncology, Maternity and Gynaecology Level 2, Women and Children’s Services, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK
                Article
                Publisher ID: 2047-0525-3-2
                DOI: 10.1186/2047-0525-3-2
                PMC ID: 4746987
                PubMed ID: 24708824
                SO-VID: 6621a83b-4c44-4f5e-b242-1208bdf7c4fc
                Copyright © Copyright © 2014 Archer et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 6 February 2014
                Date accepted : 19 March 2014
                Categories
                Subject: Research

                Keywords: enhanced recovery programmes,gynaecological cancer,patient experience
                Data availability:
                Keywords: enhanced recovery programmes, gynaecological cancer, patient experience

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