Psychological recovery after emergency laparotomy: giving patients grief

Silva, Louise, Smith, Laurie, Watts, Tessa ORCID: https://orcid.org/0000-0002-1201-5192, Bisson, Jonathan ORCID: https://orcid.org/0000-0001-5170-1243, Torkington, Jared and Cornish, Julie Anne 2024. Psychological recovery after emergency laparotomy: giving patients grief. British Journal of Surgery 111 (s8) , znae197.107. 10.1093/bjs/znae197.107

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Abstract

Aims Recent work demonstrated 8% of emergency laparotomy (EmLap) survivors were referred to mental health following surgery, suggesting it carries a significant psychological burden. This exploratory work aims to describe patients’ psychological response 1 year after EmLap using a qualitative approach. Methods POLO is a prospective cohort multicentre, mixed methods study on EmLap patients. (IRAS 301310, ClinicalTrials.Gov NCT05281627). Purposive sampling identified a subgroup to undergo 2 semi-structured interviews at 6 and 12-months post-discharge, either in person/videoconferencing, using a pre-formulated topic guide. Interviews were recorded, transcribed verbatim, and analysed using Braun and Clark’s six-step approach. Results 12 participants provided interviews at both time points. 75% were female; average age was 52 years. Patients underwent significant psychological adjustment following EmLap, similar to the Kuber-Ross Grief Reaction model; transitioning through shock, anger, bargaining, depression to eventual acceptance. Patients’ recollection of early response was disbelief, followed by anger towards their care. Bargaining centred around having restorative surgery. Depression was exacerbated by physical issues; fatigue, stoma stigma and ongoing medical treatment. Most patients reached acceptance stage by the 12-month interview. Conclusion This is the first study to describe the psychological response following EmLap. This work parallels the psychological response with other significant traumatic events, such as grief. These findings may suggest that the negative effect on patients’ mental health following surgery, observed by an increase in referral, are part of a “normal” trajectory, rather than pathological. More work is needed to understand how, and when, the response becomes problematic to functioning and long-term wellbeing.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Healthcare Sciences Medicine
Publisher:	Oxford University Press
ISSN:	1365-2168
Last Modified:	14 Oct 2024 12:30
URI:	https://orca.cardiff.ac.uk/id/eprint/172087

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