Linda Haakseth: Recovery after complex endovascular aortic repair: a person-centred approach

Abstract

Objective: There is limited knowledge about patients’ recovery after complex endovascular aortic repair (EVAR). The overall aim of this thesis was to explore patients’ recovery after complex EVAR, with a focus on patients’ experiences.

Methods: Study I explored patients’ (n=6) lived experiences of recovery after complex staged EVAR, through interviews and descriptive phenomenology. Study II investigated health and quality of life effects of complex EVAR in relation to patients’ (n=25) health and demographic characteristics, through questionnaires preoperative, one and six months postoperative. Study III explored patients’ (n=10) and healthcare professionals’ (n=12) experiences of what can improve patient recovery after EVAR, through thematic analysis of three consecutive data collection stages building on each other. Study IV explored healthcare professionals’ (n=12) descriptions of contextual factors affecting care provision towards patients’ recovery, in a secondary analysis of transcripts from study III, using the Fundamentals of Care framework.

Results: In study I the patients’ experienced a necessary, overwhelming, hard, and prolonged recovery process with life changing consequences. Study II showed patients’ health disability were significantly greater at one month postoperative, compared to preoperative. Some individuals showed impaired recovery continuing six months postoperative. In study III patients and healthcare professionals describe adequate information, patient involvement and continuity and follow-up could improve recovery. Due to influence of contextual factors, only establishing information routines were reviewed a feasible intervention by the participants. In study IV a dynamic integration of contextual factors, at an individual, system and policy level, were described to have a role to play in the patients’ recovery.

Conclusion: This thesis provides an understanding of patients’ recovery after undergoing complex EVAR, and what the healthcare services could do to support it. The results show the importance of enabling communication with the patient. Healthcare professionals and leaders need to better understand how contextual factors integrate and affect patient recovery, and take their responsibility towards common goals with the patient. Future studies should aim to better understand who is at risk of impaired recovery, and where and how in the context of care the goals of care should be set and upheld.