Patients' experiences of participating in an Enhanced Recovery After Colorectal Surgery (ERACS) program

• Main Author: Desilets, Shannon
• Language: English
• Published: University of British Columbia 2013
• Online Access: http://hdl.handle.net/2429/45452

Enhanced Recovery After Surgery (ERAS), previously called fast-track, originated in 1999 in Denmark and is gaining ever-increasing acceptance throughout North America. ERAS attempts to minimize the body’s stress response and organ dysfunction while enhancing recovery by decreasing complications and increasing feelings of wellbeing after major surgery. Patients are guided along regimented recovery periods in which they become active and engaged participants throughout all stages. The local health authority has adopted and adapted ERAS as a new surgical incentive called “Enhanced Recovery After Colorectal Surgery” (ERACS). Evidence from a large body of quantitative research has demonstrated the medical benefits of ERAS for patients, but there is limited qualitative research to understand the patient experience with no Canadian studies to date. The purpose of this qualitative study was to gain an understanding of the experiences of patients with colorectal cancer participating in this newly implemented ERACS program. The study used the narrative inquiry work of Holloway and Freshwater, plus Clandinin and Connelly. Five men and two women participated in a structured storied interview that documented the peri-operative phases of their ERACS journeys. From these interviews, Emden’s core story creation process was used to mold stories into surgical narratives using sjuzet, or organization by use of sequence and temporality. The participants’ ERACS experiences included constant motion in context to three compounding disruptions: life, time and surgical, all coming with multiple themes and sub-themes. In life disruption, they faced vulnerability as their nil to mild body clues were diagnosed with colorectal cancer. In time disruption, they reflected on their past, present and future along with a sense of changing speeds of time. In surgical disruption, they entered the hospital for surgical intervention and relayed their passage through to discharge. Their journeys were driven forward by motion and clock time, compliance, resilience, post-traumatic growth, plus the concept of non-care emerged. This study adds to the limited qualitative knowledge base and has implications for research, practice, and education. By seeking out rich experiential stories, we can listen, learn and understand to help build safe surgical programs for the benefit and care of all future ERACS patients.