Patients’ Experiences of Enhanced Recovery after Surgery: A systematic review of qualitative studies

Abstract

Aim To aggregate, interpret and synthesise findings from qualitative studies to further our knowledge regarding patients’ pre- and postoperative experiences when participating in an enhanced recovery after surgery (ERAS) program.

Background Numerous quantitative studies have documented benefits of participation in ERAS programs. Randomised control trials show that ERAS programs reduce patient morbidity and shorten hospital length of stay. However, we presently have only sparse knowledge regarding patients’ experiences of participating in these programs.

Design A qualitative systematic review and meta-synthesis.

Methods A systematic literature search of databases (Cinahl, Medline, PsycINFO, Ovid Nursing, and EMBASE) for qualitative studies published between 2000 and 2014 were undertaken. The identified studies were critically evaluated using the Critical Appraisal Skills Program, and patient experiences were synthesised into new themes by a team of researchers using qualitative content analysis.

Results Eleven studies were included. Upon analysis, four main themes emerged: information transfer, individualized treatment vs standardized care, balancing burdensome symptoms and expectations for rapid recovery, and sense of security at discharge. Information helped patients feel secure and prepared for surgery. Patients reported being motivated to participate in their recovery process. However, this became challenging when they faced symptoms such as pain, nausea, and weakness. Professional support fostered a feeling of security that was important in helping patients continue their regimen, recover, and be discharged as early as planned.

Conclusions Patients in ERAS programs desired more consistency between pre- and postoperative information. Important opportunities exist to improve symptom management and help patients feel more secure about recovery postoperatively.