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Patient expectations for recovery after elective surgery: a common-sense model approach

  • Michael B. Gehring
  • Stacee Lerret
  • Jonette Johnson
  • Julie Rieder
  • David Nelson
  • Laurel Copeland
  • Ashley Titan
  • Mary Hawn
  • Melanie Morris
  • Jeff Whittle
  • Edith BurnsEmail author
Article

Abstract

Patient perceptions of the causes of preoperative symptoms, expected impact of surgery on symptoms and anticipated timeline of recovery are likely to affect the risk of readmission following elective surgical procedures. However, these perceptions have not been studied. A qualitative study was designed to explore these perceptions, using the common-sense model of self-regulation (CSM) as the conceptual framework. CSM is grounded in illness representations, describing how patients make sense of changes in physical well-being (e.g. symptoms) and develop and assess management plans. It also establishes a broader framework for examining patients’ a priori expectations and timelines for outcomes based on comparisons to prior experiences and underlying self-prototypes, or “Self as Anchor”. A convenience sample of 14 patients aged 56–81 who underwent elective surgery was recruited. Semi-structured interviews informed by the CSM were completed on the day of discharge. Content analysis with deductive coding was used, and emerging themes were fit to components of the CSM, including the five domains of Illness Representations—identity, cause, timeline, control, and consequences. Two additional themes, outlook (toward the health care system, providers and recovery efforts), and motivation (external or internal for recovering), relate to self-prototypes, expectations for outcomes, and search for coherence. Misattribution of symptoms, unrealistic expectations for outcomes (e.g. expecting complete resolution of symptoms unrelated to the surgical procedure) and timelines for recovery (unrealistically short), and the (baseline) “normal healthy self” as distinct from the (temporarily) “sick self” were recurrent themes. Findings suggest that patient perceptions and the actual recovery process may be misaligned. The results underscore the importance of assessing patients’ perceptions and expectations, actively engaging patients in their own healthcare, and providing adequate support during the transition to home.

Keywords

Patient perceptions Surgical recovery Common-sense self-regulation model Self-prototype Transitions of care 

Notes

Funding

This research was supported through funding by the National Institute on Aging (NIA) and the American Federation on Aging Research (AFAR) through the Medical Student Training in Aging Research (MSTAR) Program, and by Grants T35 AG029793-11 and VHA HX001108-01A2.

Compliance with ethical standards

Conflict of interest

Michael B. Gehring, Stacee Lerret, Jonette Johnson, Julie Rieder, David Nelson, Laurel Copeland, Ashley Titan, Mary Hawn, Melanie Morris, Jeff Whittle, Edith Burns declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Michael B. Gehring
    • 1
    • 2
  • Stacee Lerret
    • 2
  • Jonette Johnson
    • 1
    • 2
  • Julie Rieder
    • 1
    • 2
  • David Nelson
    • 2
  • Laurel Copeland
    • 4
  • Ashley Titan
    • 5
    • 6
  • Mary Hawn
    • 5
    • 6
  • Melanie Morris
    • 7
    • 8
  • Jeff Whittle
    • 1
    • 2
  • Edith Burns
    • 1
    • 2
    • 3
    Email author
  1. 1.Zablocki Veterans Affairs Medical CenterMilwaukeeUSA
  2. 2.Medical College of WisconsinMilwaukeeUSA
  3. 3.Center for Health Innovations and Outcomes Research, Zucker School of Medicine at Hofstra/Northwell, 600 Community Drive, Suite 403ManhassetUnited States
  4. 4.VA Central Western Massachusetts Healthcare SystemLeedsUSA
  5. 5.Veterans Affairs Medical CenterPalo AltoUSA
  6. 6.Department of SurgeryStanford University School of MedicinePalo AltoUSA
  7. 7.Birmingham VAMCBirminghamUSA
  8. 8.University of Alabama School of MedicineBirminghamUSA

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