The drama of being diagnosed with an aortic aneurysm and undergoing surgery for two different procedures: open repair and endovascular techniques

Patients' body image after open abdominal surgery of abdominal aortic aneurysm - Perceptions and experiences

Aims

To explore and gain an understanding of patients’ perceptions and experiences of their body and bodily function in connection with open surgery of abdominal aortic aneurysm.

Background

After the operation of an abdominal aortic aneurysm (AAA) it may be difficult for the patients to understand what the procedure means.

Design

The design was descriptive and based on an analysis of 13 audio‐taped consultations with patients undergoing open surgery for AAA at a Swedish university hospital. The patients’ age varied from 57–79 and the mean age was 71 (70.5 female).

Methods

A hermeneutic approach was used whereby patients were interviewed and draw a picture of their thoughts and experiences of the surgery and what had been done in their bodies. Once patients had finished their drawings, the interviewer asked what thoughts and experiences they had of the AAA.

Results

Patients described experiences as a process of “going from broken to whole again.”

Patient-Reported Outcomes of Yearly Imaging Surveillance in Patients Following Endovascular Aortic Aneurysm Repair

Little is known about the impact of standardized imaging surveillance on anxiety levels and well-being of patients after endovascular aortic aneurysm repair (EVAR). We hypothesize that patient anxiety levels increase just before receiving the imaging results compared with standard anxiety levels.

METHODS

Prospective cohort study from November 2018 to May 2020 including post-EVAR patients visiting the outpatient clinics of 4 Dutch hospitals for imaging follow-up. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used. Patients completed the PROMIS Anxiety v1.0 Short Form (SF) 4a, PROMIS-Global Health Scale v1.2, and PROMIS-Physical Function v1.2 SF8b at 2 time points: prior to the result of the imaging study (T1: pre-visit) and 6-8 months later (T2: reference measurement). Mean T-scores at T1 were compared to T2, and T2 to the general 65+ Dutch population.

RESULTS

Altogether 342 invited patients were eligible, 214 completed the first questionnaire, 189 returned 2 completed questionnaires and 128 patients did not participate. Out of 214 respondents, 195 were male (91.1%) and the mean (standard deviation) age was 75.2 (7.0) years. There were no significant differences between T1 and T2 in anxiety levels (0.48; 95% confidence interval[CI] -0.42-1.38), global mental health (0.27; 95% CI -0.79-0.84), global physical health (0.10; 95% CI -0.38-1.18) and physical function (0.53; 95% CI -0.26-1.32). Compared with the 65+ Dutch population, at T2 patients experienced more anxiety (3.8; 95% CI 2.96-5.54), had worse global physical health (-3.2; 95% CI -4.38 - -2.02) and physical function (-2.4; 95% CI -4.00 - -0.80). Global mental health was similar (-1.0; 95% CI -2.21 - 0.21).

CONCLUSIONS

Post-EVAR patients do not experience more anxiety just before receiving surveillance imaging results than outside this period, but do suffer from more anxiety and worse physical outcomes than the 65+ Dutch population.

Patients' perspective on prostatic artery embolization: A qualitative study

Objectives

The aim was to describe the patients' experience of undergoing prostatic artery embolization.

Methods

A retrospective qualitative interview study was undertaken with 15 patients of mean age 73 years who had undergone prostatic artery embolization with a median duration of 210 min at two medium sized hospitals in Sweden. The reasons for conducting prostatic artery embolization were clean intermittent catheterization (n = 4), lower urinary tract symptoms (n = 10) or haematuria (n = 1). Data were collected through individual, semi-structured telephone interviews 1-12 months after treatment and analysed using qualitative content analysis.

Results

Four categories with sub-categories were formulated to describe the results: a diverse experience; ability to control the situation; resumption of everyday activities and range of opinions regarding efficacy of outcomes. Overall, the patients described the procedure as painless, easy and interesting and reported that while the procedure can be stressful, a calm atmosphere contributed to achieving a good experience. Limitations on access to reliable information before, during and after the procedure were highlighted as a major issue. Practical ideas for improving patient comfort during the procedure were suggested. Improved communications between treatment staff and patients were also highlighted. Most patients could resume everyday activities, some felt tired and bruising caused unnecessary worry for a few. Regarding functional outcome, some patients described substantial improvement in urine flow while others were satisfied with regaining undisturbed night sleep. Those with less effect were considering transurethral resection of the prostate as a future option. Self-enrolment to the treatment and long median operation time may have influenced the results.

Conclusions

From the patients' perspective, prostatic artery embolization is a well-tolerated method for treating benign prostate hyperplacia.

Health-related quality of life in patients with abdominal aortic aneurysm undergoing endovascular aneurysm repair: A cross-sectional study

BACKGROUND

Endovascular aneurysm repair (EVAR) has become a common surgical treatment for abdominal aortic aneurysm (AAA), and postoperative health-related quality of life (HRQoL) is drawing increasing attention. Most studies compare HRQoL in EVAR patients and open aneurysm repair patients, while few studies have investigated HRQoL in EVAR patients versus the general population. This study aimed to investigate whether HRQoL differs between patients with EVAR patients and the general population.

METHODS

EVAR patients were recruited from a medical center in northern Taiwan. General population subjects and the EVAR patients were paired based on age and sex, and a simple random sampling method was used for sampling at 2:1. In this study, we used the World Health Organization Quality of Life Scale Abbreviated Version, Taiwan Version to investigate HRQoL. A multivariate regression model was used to analyze intergroup differences related to facets and domains.

RESULTS

A total of 58 patients with EVAR and 116 individuals from the general population were included in this study. The EVAR patients' mean scores for overall QoL and the physical domain, psychological domain, social relations domain, and environment domain were 3.79, 15.53, 15.00, 14.93, and 15.57, respectively, and all of these scores were significantly higher than those in the general population. In addition, the β values (β = 0.21, 0.73, 1.83, 0.81, and 2.62, respectively) of the EVAR patients were also significantly higher in the multivariate analysis. The findings showed that a high education level and nonsmoking status were associated with higher HRQoL, while unemployment was associated with lower HRQoL.

CONCLUSION

EVAR patients had higher HRQoL than the general population, indicating that patients with AAA have a high likelihood of recovering and enjoying high HRQoL if they receive appropriate medical procedures and nursing education.

Life is about so much more: Patients' experiences of health, well-being, and recovery after operation of abdominal aortic aneurysm with open and endovascular treatment-A prospective study

Different surgical treatments for abdominal aortic aneurysm can lead to different perceptions of health and well-being. The aim of this study was to describe patients' well-being, sense of coherence (SOC), and experiences of surgery after open and endovascular treatment one month and one and 2 years after the procedure. Seventy six patients participated (40 open repair; 36 endovascular aneurysm repair). The study was conducted using the SOC questionnaire, and specific questions about patients' experiences of the surgical treatment and well-being. After 2 years, no patient regretted the operation or considered it to be the most difficult experience they had ever had. Twenty percent of the patients were worried about complications one month after the operation. Both groups experienced difficulty in returning to normal activity after surgery at one month. At one and 2 years after the surgery, patients in both groups stated that it was other things in life that affected their well-being. The endovascular aneurysm repair group reported a significant decrease in SOC from baseline until one year (P = .012) and 2 years (P = .033). The open repair group reported a significant decrease after one year (0.033). The operation did not affect patients' way of thinking about the disease. Patients in both groups stated that it was other circumstances in life that affected their well-being one and 2 years after the treatment, which could indicate that long-term follow-up would not be necessary from a patient perspective. The operation affects patients' well-being a short time after the operation.

A critical analysis of articles using a Gadamerian based research method

It is over 20 years since Michael Crotty's groundbreaking critique of phenomenological research in nursing. However, rather than entering into the acrimonious discussions that followed, we developed a research method that we believed translated Gadamer's philosophy into the world of empirical research. Fundamental to that work was our differentiation of hermeneutics from phenomenology. The aim of the present paper was to provide a critical analysis of the citations from publication in 2003 until the end of 2017. We identified 402 citations of which 362 were included. One hundred and sixty-three articles mentioned the article in passing, usually in a list of authors who had discussed hermeneutics. Sixteen citations misrepresented the method mainly claiming that we discussed a method for hermeneutic phenomenology (or phenomenological hermeneutics). Of the 117 citations that partially used the method, the main focus was the four steps of data analysis. Sixty studies used our method in totality although they derive from varying philosophical standpoints. Disappointingly, there has been little critique of our Gadamerian research method. For health disciplines to truly make progress in the academic stage, it is vital that we engage in with critique, some of which will come through open and honest reflexive engagement with our topics.

Experiences of the screening process and the diagnosis abdominal aortic aneurysm among 65-year-old men from invitation to a 1-year surveillance

The prevalence of abdominal aortic aneurysm (AAA) is reported to be 2.2%-8% among men >65 years. During recent years, screening programs have been developed to detect AAA, prevent ruptures, and thereby saving lives. Therefore, most men with the diagnosis are monitored conservatively with regular reviews. The objective of the study was to describe how men diagnosed with abdominal aortic aneurysm <55 mm discovered by screening experience the process and diagnosis from invitation to 1 year after screening. A total of eleven 65-year-old men were included in three focus groups performed in a University Hospital in Sweden. These were qualitatively analyzed using manifest and latent content analysis. The experience of the screening process and having an abdominal aortic aneurysm in a long-term perspective revealed three categories: "trusting the health care system," emphasizing the need for continual follow-ups to ensure feelings of security; "the importance size," meaning that the measure was abstract and hard to understand; and "coping with the knowledge of abdominal aortic aneurysm," denoting how everyday life was based mostly on beliefs, since a majority lacked understanding about the meaning of the condition. The men want regular surveillance and surrendered to the health care system, but simultaneously experienced a lack of support thereof. Knowing the size of the aorta was important. The men expressed insecurity about how lifestyle might influence the abdominal aortic aneurysm and what they could do to improve their health condition. This highlights the importance of communicating knowledge about the abdominal aortic aneurysm to promote men's feelings of security and giving space to discuss the size of the aneurysm and lifestyle changes.