title: Patient perspective on care transitions after colorectal surgery.
abstract: The surgical care pathway is characterized by multiple transitions, from preoperative assessment to inpatient stay, discharge from hospital, and follow-up care. Breakdowns in one phase can affect subsequent phases, which in turn can cause delays, cancellations, and complications. Efforts to improve care transitions focused primarily on post-discharge care coordination and inpatient education for medically complex patients have not demonstrated consistent effects. This study aimed to understand the expectations and perceptions of postoperative inpatients regarding transition from hospital to home in an effort to reduce patient burden.
  
  
  
  Patients who underwent a colorectal resection at a large academic medical center and were discharged home were eligible to participate in the study. Patients were recruited during their postoperative hospital stays and interviewed over the phone within a week after discharge about their perceptions of care, values, and attitudes. Overall, we recruited 16 patients with benign (n = 8) and malignant (n = 8) indications. Recruitment continued until theme saturation.
  
  
  
  Factors that shaped patients' understanding of postsurgical recovery and that motivated them to seek provider attention post-discharge fell into three major groups: patient expectations versus reality, availability and role of informal caregivers in the postoperative recovery process, and communication as a key to patient confidence and trust.
  
  
  
  For patients and caregivers, postoperative planning starts long before surgery and hospital admission. Providers should consider these dynamics in designing interventions to improve care transitions, patient satisfaction, and long-term outcomes. This study was limited to colorectal surgical patients treated in a single institution and may be not generalizable to other surgical procedures, non-academic settings or different regions.
authors.affiliation: Surgical Health Outcomes & Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Kelly
authors.affiliation: Surgical Health Outcomes & Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York. Electronic address: katia_noyes@urmc.rochester.edu.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York.
authors.forename: James
authors.initials: J
authors.lastname: Dolan
authors.affiliation: Surgical Health Outcomes & Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Fergal
authors.initials: F
authors.lastname: Fleming
authors.affiliation: Surgical Health Outcomes & Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
authors.affiliation: Surgical Health Outcomes & Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Maynor
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York.
authors.forename: Ann
authors.initials: A
authors.lastname: Dozier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery*; D003266:Continuity of Patient Care; D013505:Digestive System Surgical Procedures; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011182:Postoperative Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012007:Rectum / Q000601:surgery*; D055815:Young Adult
keywords: Colorectal; Communication; Hospital discharge; Informal caregiver; Patient perspective; Qualitative research