Underserved Patients Seeking Care for Ventral Hernias at a Safety Net Hospital: Impact on Quality of Life and Expectations of Treatment - 19/04/17
, Isabel M. Leal, PhD, Juan R. Flores, MD, Julie L. Holihan, MD, Blake E. Henchcliffe, MBA, Thomas O. Mitchell, BA, Tien C. Ko, MD, FACS, Mike K. Liang, MD, FACS, Lillian S. Kao, MD, MS, FACSAbstract |
Background |
The purpose of this study was to identify issues important to patients in their decision-making, expectations, and satisfaction when seeking treatment for a ventral hernia.
Study Design |
An exploratory qualitative study was conducted of adult patients with ventral hernias seeking care at a safety-net hospital. Two semi-structured interviews were conducted with each patient: before and 6 months after surgical consultation. Interviews were audiotaped, transcribed, and coded using latent content analysis until data saturation was achieved.
Results |
Of patients completing an initial interview (n = 30), 27 (90%) completed follow-up interviews. Half of the patients were Spanish-speaking, one-third had a previous ventral hernia repair, and two-thirds underwent initial nonoperative management after surgical consultation. Patient-described factors guiding management decisions included impact on quality of life, primarily pain and limited function; overwhelming challenges to meeting surgical criteria, primarily obesity; and assuming responsibility to avoid recurrence. Patients were uninformed regarding potential poor outcomes and contributing factors, even among patients with a previous ventral hernia repair, with most attributing recurrence to inadequate self-management.
Conclusions |
Understanding patients' perspective is crucial to engaging them as stakeholders in their care, addressing their concerns, and improving clinical and patient-centered outcomes. Patient reports suggest how care can be improved through developing more effective strategies for addressing patients' concerns during nonoperative management, preoperative risk reduction strategies that are sensitive to their sociodemographic characteristics, treatment plans that harness patients' willingness for self-management, and patient education and decision-making tools.
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| CME questions for this article available at jacscme.facs.org |
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| Drs Alawadi and Leal contributed equally to this work. |
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| Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. |
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| Support: This work was supported by the Center for Clinical and Translational Sciences, which is funded by National Institutes of Health Clinical and Translational Award UL1 TR000371 and KL2 TR000370 from the National Center for Advancing Translational Sciences. |
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| Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. |
Vol 224 - N° 1
P. 26 - janvier 2017 Retour au numéro
Article précédent
- Do No Harm, Except to Ourselves? A Survey of Symptoms and Injuries in Oncologic Surgeons and Pilot Study of an Intraoperative Ergonomic Intervention
- Rachel K. Voss, Yi-Ju Chiang, Kate D. Cromwell, Diana L. Urbauer, Jeffrey E. Lee, Janice N. Cormier, Chee-Chee H. Stucky
- Hidden Morbidity of Ventral Hernia Repair with Mesh: As Concerning as Common Bile Duct Injury?
- Kristy Kummerow Broman, Li-Ching Huang, Adil Faqih, Sharon E. Phillips, Rebeccah B. Baucom, Richard A. Pierce, Michael D. Holzman, Kenneth W. Sharp, Benjamin K. Poulose
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