Supportive Care in Cancer

, Volume 24, Issue 8, pp 3447–3454 | Cite as

‘Am I really ready to go home?’: a qualitative study of patients’ experience of early discharge following an enhanced recovery programme for liver resection surgery

  • T. VandrevalaEmail author
  • V. Senior
  • L. Spring
  • L. Kelliher
  • C. Jones
Original Article



Fast-track surgery or enhanced recovery programmes (ERP) have been shown to improve patient outcomes with shorter post-operative recovery times, fewer complications and more cost-effective care amongst the reported benefits. Traditionally, the effectiveness of ERPs have been assessed by measuring clinical outcomes, with the patient experience often being neglected. The aim of this qualitative study was to ascertain patients’ expectations and experiences of fast-track surgery and recovery at home within the setting of an enhanced recovery programme (ERP).


Twenty patients enrolled in the treatment group of the randomised controlled trial ‘Enhanced recovery in liver resection surgery’ were interviewed pre-operatively and 6 weeks post-surgery. Transcripts were analysed using thematic analysis.


Patients approached the surgery with a sense of renewed hope. Involvement with the ERP was viewed positively, and having milestones to aim for gave patients a sense of purpose. Many felt that real recovery from surgery began at home and so felt positive about having an early discharge. Patients did report some concerns about being discharged early and those who failed to meet milestones or were readmitted to hospital experienced this as failure.


This qualitative data demonstrates some of the complexities of patients’ expectations and experiences of the ERP. Whilst patients generally experience the ERP positively, they also have concerns about the process. The study highlights areas where additional support may be needed for patients enrolled in ERPs and discharged early.


Qualitative research Enhanced recovery programmes Liver cancer Discharge from hospital 


Compliance with ethical standards

Ethical approval for the main trail and this qualitative study was received from National Health Service Research Ethics Committee and monitored by the Trust Research and Development Department.

Conflict of Interest

No funding was received for this project.

We have full control of all primary data and agree to allow the journal to review their data if requested.


  1. 1.
    Gouvas et al (2009) Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24:1,119–1,131CrossRefGoogle Scholar
  2. 2.
    Grover M (2010) Enhanced recovery after colorectal surgery. Curr Anaesth Crit Care 21:121–124CrossRefGoogle Scholar
  3. 3.
    Jones C et al (2013) Randomized clinical trial on enhanced recovery versus standard care following open liver resection. BJS 100:1015–1024CrossRefGoogle Scholar
  4. 4.
    Varadhan KK et al (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomised controlled trials. Clin Nutr 29:434–440CrossRefPubMedGoogle Scholar
  5. 5.
    Levy BF et al (2009) 23-hour-stay laparoscopic colectomy. Dis Colon Rectum 52:1239–1243CrossRefPubMedGoogle Scholar
  6. 6.
    Lv D, Wang X, Shi G (2010) Perioperative enhanced recovery programmes for gynaecological cancer patients. Cochrane Database Syst Rev Issue 6:CD008239. doi: 10.1002/14651858.CD008239.pub2 Google Scholar
  7. 7.
    Preston SR et al (2013) Impact of a multidisciplinary standardized clinical pathway on perioperative outcomes in patients with oesophageal cancer. Br J Surg 100:105–112CrossRefPubMedGoogle Scholar
  8. 8.
    Walter C et al (2008) Patients’ perceptions of pre-operative enhanced information leaflets for fast-track colorectal resections: a qualitative study. CARE 2:72–93Google Scholar
  9. 9.
    Khan S et al (2010) Quality of life and patient satisfaction with enhanced recovery protocols. Color Dis 12:1175–1182CrossRefGoogle Scholar
  10. 10.
    Paton F et al (2014) Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis. BMJ 4, e005015. doi: 10.1136/bmjopen-2014 CrossRefGoogle Scholar
  11. 11.
    Levy BF et al (2011) Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing colorectal surgery. Br J Surg 98:1068–1078CrossRefPubMedGoogle Scholar
  12. 12.
    Feldman LS, Lee L, Fiore J (2015) What outcomes are important in the assessment of enhanced recovery after surgery (ERAS) pathways? Can J Anesth 62:120–130CrossRefPubMedGoogle Scholar
  13. 13.
    Lassen K et al (2009) Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg 144:961–969CrossRefPubMedGoogle Scholar
  14. 14.
    Savikko J et al (2015) Enhanced recovery protocol after liver resection. BJS 102:1526–1532CrossRefGoogle Scholar
  15. 15.
    Wang H et al (2013) Short-term quality of life in patients undergoing colonic surgery using enhanced recovery after surgery program versus conventional perioperative management. Qual Life Res. doi: 10.1007/s11136-015-0996-5 Google Scholar
  16. 16.
    Blazeby JM et al (2010) A qualitative evaluation of patients’ experiences of an enhanced recovery programme for colorectal cancer. Color Dis 12:e236–e242. doi: 10.1111/j.1463-1318.2009.02104.x CrossRefGoogle Scholar
  17. 17.
    Moore G (2015) Process evaluation of complex interventions: Medical Research Council guidance. BMJ 350:h1258. doi: 10.1136/bmj.h1258 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Aasa A, Hovback M, Bertoro C (2013) The importance of preoperative information for patient participation in colorectal surgery care. J Clin Nurs 22:1604–1612. doi: 10.1111/jocn.12110 CrossRefPubMedGoogle Scholar
  19. 19.
    Norlyk A, Harder I (2009) After colonic surgery: the lived experience of participating in a fast-track surgery. Intern J Qual Stud Health Well-being 4:170–180CrossRefGoogle Scholar
  20. 20.
    Norlyk A, Harder I (2011) Recovering at home: participating in a fast-track colon cancer surgery programme. Nurs Inq 18:165–173. doi: 10.1111/j.1440-1800.2011.00519.x CrossRefPubMedGoogle Scholar
  21. 21.
    Archer S, Montague J, Bali A (2014) Exploring the experience of an enhanced recovery programme for gynecological cancer patients: a qualitative study. Perioper Med 3:2. doi: 10.1186/2047-0525-3-2 CrossRefGoogle Scholar
  22. 22.
    Wagner L et al (2004) Patient and staff (doctors and nurses) experiences of abdominal hysterectomy in accelerated recovery programme. Dan Med Bull 51:418–421PubMedGoogle Scholar
  23. 23.
    Roberts J et al (2010) Thinking differently: working to spread enhanced recovery across England. Curr Anaesth Crit Care 21:137–141. doi: 10.1016/j.cacc.2009.12.003 CrossRefGoogle Scholar
  24. 24.
    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101, ISSN 1478-0887CrossRefGoogle Scholar
  25. 25.
    Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24:105–112CrossRefPubMedGoogle Scholar
  26. 26.
    Sahlsten MJ et al (2009) Nurse strategies for optimising patient participation in nursing care. Scand J Caring Sci 23:490–497CrossRefPubMedGoogle Scholar
  27. 27.
    Bruce J et al (2014) Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain 155:232–243CrossRefPubMedGoogle Scholar
  28. 28.
    Antoni MH et al (2001) Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhanced benefit finding among women under treatment for early-stage breast cancer. Health Psychol 20:20–32CrossRefPubMedGoogle Scholar
  29. 29.
    Lawrence-Smith G, Sturgeon D (2013) Treating learned helplessness in hospital: a re-acquaintance with self-control. Br J Hosp Med 67:134–136. doi: 10.12968/hmed.2006.67.3.20616 CrossRefGoogle Scholar
  30. 30.
    Jonsson CA, Stenberg A, Frisman GH (2010) The lived experiences of the early postoperative period after colorectal cancer surgery. Eur J Cancer Care 20:248–256CrossRefGoogle Scholar
  31. 31.
    Department of Health (2010) Ready to go? Planning the discharge and the transfer of patients from hospital and intermediate care. Department of Health, LondonGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Faculty of Arts & Social SciencesKingston UniversityKingstonUK
  2. 2.Department of PsychologyBPP UniversityLondonUK
  3. 3.Department of Hepatopancreaticobiliary SurgeryRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
  4. 4.Department of AnaesthesiaRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK

Personalised recommendations