Participation in Surgical Cancer Care

Implementation of Fast-track surgery programs for patients with tumors in the upper GI-tract are steadily increasing because of the decreased costs, shorter hospital stays and a decrease in morbidity, mortality and post-operative complications associated with Fast-track programs. The health care team follows a standardized care program consisting of a check list with day-to-day evidence based procedures which reduces postoperative complications. Postoperative recovery is described as a process in which patients strive for a return to a normalized daily life.

Major surgeries are associated with pain, nausea, postoperative ileus , fatigue, post-operative complications such as wound infections , heart or lung dysfunctions and thromboembolic complications. In the last 20 years perioperative care, anesthesia and surgery for patients suffering from tumors has developed greatly. This has led to development and evaluation of concepts to enhance the patients recovery after different types of surgery. Fast-track surgery concepts results in decreased morbidity and enhanced recovery by implemented evidence based principles in analgesia, anesthesia, fluid management, nutrition, ambulation, minimal invasive surgery and reduction of surgical stress.

In recent years there's been a shift in focus of patient care. Patients are moving from a passive role to being more participant in their care. In Sweden, patients have the legal right to participate in their own care, and health care should be individualized for each patient's needs and abilities. Being involved in your own health care contributes to increased motivation and an improvement of the situation. This may in some cases lead to better treatment outcomes and greater satisfaction with the given care. A severe symptom burden can make the patient a passive recipient of health care without initiative or strength to be involved in the care. In patients with malignancies of the upper gastrointestinal tract monitoring and symptom relief of importance to stimulate opportunities for participation.

Aim

To investigate and describe patient participation among patients who had surgery for liver, bile duct (cholangiocarcinoma) and pancreatic cancer and follow a fast-track recovery program.

Specific aims

• To identify and describe patient participation in patients who follow a fast track-care concept
• To explore patients experiences of patient participation
• To identify, describe and evaluate patient assessed health related quality of life; and relations with patient participation

Consecutive sampling strategy, patients will be screened and asked for participation both in verbal and written information. The responsibility health care professionals judge about the patient's condition to participate in the study, according to the inclusion and exclusion criteria.

Inclusion criteria

• patients who had surgery for liver, bile duct and pancreatic cancer and follow a fast-track recovery program >18 years old

Exclusion criteria

• cognitive dysfunction
• could not master the Swedish language