Discharge education delivered to general surgical patients in their management of recovery post discharge: A systematic mixed studies review

Abstract

Background: Discharge education is essential for postoperative general surgery patients for their self-management of care at home post discharge. The first 30 days’ post-surgery is pivotal to the post-operative recovery process as this is when most post-operative complications occur. Insufficient discharge education can compromise patients’ recovery process causing postoperative complications and unplanned hospital readmissions. Objectives: To identify the discharge education provided to general surgery patients. Design: Systematic mixed studies review. Data sources: Literature data sources were searched from December 2017 to January 2018 using the four databases: EBSCO CINAHL Plus, EBSCO MEDLINE, Ovid EMBASE and COCHRANE Library. Searches were supplemented with hand searching of reference lists. Review methods: The relevance of the articles was reviewed using the inclusion and exclusion criteria; included data were extracted and presented in a summary table. Two reviewers appraised the methodological quality of the articles using the Mixed Methods Appraisal Tool. Discussions were held to examine emergent themes, quality scores of the studies, and agreement reached by consensus. Themes were derived through inductive analysis. Results: A total of 468 records were screened for titles and abstracts and 7 studies met the inclusion criteria. There was a mix of qualitative and quantitative studies. The majority of the included sample were patients with one quantitative study including patients’ family and nurses. Discharge education was delivered at various timing and at different doses during the surgical process. Education delivered was mostly standardised and some of the discharge interventions were tailored and included a checklist for stoma care and a discharge warning tool. Four themes were identified: quality of discharge education influences its uptake, health care professionals’ perceptions of their role in the delivery of discharge education to patients, patients’ preferences for education delivery and patients’ participation in their self-care. Conclusions: The quality of discharge education has an influence on patient participation in their management of care post discharge. Assessing patients’ preparedness for discharge is an essential component of discharge planning process. The presentation, timing and frequency of discharge education was important in the delivery of information. Tailored education reflecting the learning needs of patients using multiple media delivered in varying doses enhanced patients’ overall knowledge for successful management of recovery post discharge. The scarcity of recent literature in discharge education indicates that the quantity of evidence regarding discharge education intervention in general surgery patients is low and further work in this area needs to be undertaken