Patient expectations for recovery after elective surgery: a common-sense model approach
Patient perceptions of the causes of preoperative symptoms, expected impact of surgery on symptoms and anticipated timeline of recovery are likely to affect the risk of readmission following elective surgical procedures. However, these perceptions have not been studied. A qualitative study was designed to explore these perceptions, using the common-sense model of self-regulation (CSM) as the conceptual framework. CSM is grounded in illness representations, describing how patients make sense of changes in physical well-being (e.g. symptoms) and develop and assess management plans. It also establishes a broader framework for examining patients’ a priori expectations and timelines for outcomes based on comparisons to prior experiences and underlying self-prototypes, or “Self as Anchor”. A convenience sample of 14 patients aged 56–81 who underwent elective surgery was recruited. Semi-structured interviews informed by the CSM were completed on the day of discharge. Content analysis with deductive coding was used, and emerging themes were fit to components of the CSM, including the five domains of Illness Representations—identity, cause, timeline, control, and consequences. Two additional themes, outlook (toward the health care system, providers and recovery efforts), and motivation (external or internal for recovering), relate to self-prototypes, expectations for outcomes, and search for coherence. Misattribution of symptoms, unrealistic expectations for outcomes (e.g. expecting complete resolution of symptoms unrelated to the surgical procedure) and timelines for recovery (unrealistically short), and the (baseline) “normal healthy self” as distinct from the (temporarily) “sick self” were recurrent themes. Findings suggest that patient perceptions and the actual recovery process may be misaligned. The results underscore the importance of assessing patients’ perceptions and expectations, actively engaging patients in their own healthcare, and providing adequate support during the transition to home.
KeywordsPatient perceptions Surgical recovery Common-sense self-regulation model Self-prototype Transitions of care
This research was supported through funding by the National Institute on Aging (NIA) and the American Federation on Aging Research (AFAR) through the Medical Student Training in Aging Research (MSTAR) Program, and by Grants T35 AG029793-11 and VHA HX001108-01A2.
Compliance with ethical standards
Conflict of interest
Michael B. Gehring, Stacee Lerret, Jonette Johnson, Julie Rieder, David Nelson, Laurel Copeland, Ashley Titan, Mary Hawn, Melanie Morris, Jeff Whittle, Edith Burns declare that they have no conflict of interest.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- Benyamini, Y., Burns, E. (2019). Images of aging: Older adults’ self-perceptions of age and of health. European Journal of Behavioral Medicine (in press).Google Scholar
- Bernstein, G. M., & Offenbartl, S. K. (1991). Adverse surgical outcomes among patients with cognitive impairments. American Surgeon, 57, 682–690.Google Scholar
- Careyva, B., Shaak, K., Mills, G., Johnson, M., Goodrich, S., Stello, B., et al. (2016). Implementation of technology-based patient engagement strategies within practice-based research networks. The Journal of the American Board of Family Medicine. https://doi.org/10.3122/jabfm.2016.05.160044 Google Scholar
- Cooper, V., Metcalf, L., Versnel, J., Upton, J., Walker, S., & Horne, R. (2015). Patient-reported side effects, concerns and adherence to corticosteroid treatment for asthma, and comparison with physician estimates of side-effect prevalence: A UK-wide cross-sectional study. NPJ Primary Care Respiratory Medicine. https://doi.org/10.1038/npjpcrm.2015.26 Google Scholar
- Fisher, A. V., Campbell-Flohr, S. A., Sell, L., Osterhaus, E., Acher, A. W., Leahy-Gross, K., et al. (2018). Adaptation and implementation of a transitional care protocol for patients undergoing complex abdominal surgery. Joint Commission Journal on Quality and Patient Safety. https://doi.org/10.1016/j.jcjq.2018.05.001 Google Scholar
- Leventhal, H., Weinman, J., Leventhal, E. A., & Phillips, L. A. (2008). Health psychology: The search for pathways between behavior and health. Annual Review of Psychology. https://doi.org/10.1146/annurev.psych.59.103006.093643 Google Scholar
- Mayring, P. (2000). Qualitative Content Analysis [28 paragraphs]. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 1(2), 20. http://nbn-resolving.de/urn:nbn:de:0114-fqs0002204.Google Scholar
- Mora, P. A., DiBonaventura, M. D., Idler, E., Leventhal, E. A., & Leventhal, H. (2008). Psychological factors influencing self-assessments of health: Toward an understanding of the mechanisms underlying how people rate their own health. Annals of Behavioral Medicine. https://doi.org/10.1007/s12160-008-9065-4 Google Scholar
- Neumann, E., Grindel, S., Urbain, J., Rosenthal, A., Tarima, S., Mickschl, D., & Burns, E. (2019). Self-prototypes and long-term self-management of chronic shoulder impairment: Using Kinect™-generated imagery to address unrealistic patient expectations. Clinical Health Psychology (in press).Google Scholar