Underserved Patients Seeking Care for Ventral Hernias at a Safety Net Hospital: Impact on Quality of Life and Expectations of Treatment
- 11 October 2016
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 224 (1), 26-34e2
- https://doi.org/10.1016/j.jamcollsurg.2016.09.017
Abstract
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. 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. 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. 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.Keywords
This publication has 40 references indexed in Scilit:
- A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic settingBMC Health Services Research, 2013
- Mobile phone messaging for facilitating self-management of long-term illnessesCochrane Database of Systematic Reviews, 2012
- Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled studySurgical Endoscopy, 2012
- Shared Decision Making — The Pinnacle of Patient-Centered CareThe New England Journal of Medicine, 2012
- Racial-Ethnic Disparities in Stroke Care: The American ExperienceStroke, 2011
- Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals’ perceptionsPatient Education and Counseling, 2008
- Socioeconomic Status and ObesityEpidemiologic Reviews, 2007
- The Obesity Epidemic in the United States Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression AnalysisEpidemiologic Reviews, 2007
- Bridging the digital divide: Reaching vulnerable populationsJournal of the American Medical Informatics Association, 2004
- Social inequalities in health: Next questions and converging evidenceSocial Science & Medicine, 1997