Predictors of preparedness for recovery following colorectal cancer surgery: a latent class trajectory analysis

Abstract

Aim

With an interest in providing knowledge for person-centred care, our overall goal is to contribute a greater understanding of diversity among patients in terms of their preparedness before and up to six months after colorectal cancer surgery. Our aim was to describe and provide a tentative explanation for differences in preparedness trajectory profiles.

Material and methods

The study was explorative and used prospective longitudinal data from a previously published intervention study evaluating person-centred information and communication. The project was conducted at three hospitals in Sweden. Patient-reported outcomes measures, including the Longitudinal Preparedness for Colorectal Cancer Surgery Questionnaire, were collected before surgery, at discharge, and four to six weeks, three months, and six months after surgery. Clinical data were retrospectively obtained from patients’ medical records. We used latent class growth models (LCGMs) to identify latent classes that distinguish subgroups of patients who represent different preparedness trajectory profiles. To determine the most plausible number of latent classes, we considered statistical information about model fit and clinical practice relevance. We used multivariable regression models to identify variables that explain the latent classes.

Results

The sample (N = 488) comprised people with a mean age of 68 years (SD = 11) of which 44% were women. Regarding diagnoses, 60% had colon cancer and 40% rectal cancer. The LCGMs identified six latent classes with different preparedness for surgery and recovery trajectories. The latent classes were predominantly explained by differences in age, sex, physical classification based on comorbidities, treatment hospital, global health status, distress, and sense of coherence (comprehensibility and meaningfulness).

Conclusion

Contrary to the received view that emphasizes standardized care practices, our results point to the need for adding person-centred and tailored approaches that consider individual differences in how patients are prepared before and during the recovery period related to colorectal cancer surgery.

Keywords:

• Colorectal neoplasms
• health communication
• longitudinal studies
• patient acceptance of health care
• patient-centred care
• quality of life

Acknowledgments

Thank you to all the professionals involved for all efforts made to support the project and for invaluable contributions by: the research nurse assistants Matilda Örn, Anneli Ringström, Marina Modin and Nina Blommé; to the facilitators Anna Garpenbeck, Karin Hassel, Anna Johansson, Sabina Kalabic, Gunilla Kokko, Lotta Kämpe, Simona Magnusson, Monika Silebäck and Stefan Skullman; to co-investigators Febe Friberg, Lars-Christier Hydén, Karl Kodeda, Dimitrios Kokkinakkis, Sylvia Määttä and Catarina Wallengren, and to Lena Hansson Ström and Marie Tauson for initiating the discussion and paving the way for the project.-

Ethical approval

Approval from the Regional Ethical Review Board in Gothenburg was obtained (Dnr 536-12).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data cannot be shared publicly because the questionnaires include sensitive data about health status. The ethical approval by the Regional Ethical Review Board in Gothenburg, Sweden includes a statement that the data will be kept in a private repository. Requests for the data used in our analyses can be made to Swedish National Data Service [email protected].

Additional information

Funding

This work was supported by the Centre for Person-Centred Care at the University of Gothenburg (GPCC; funded by the Swedish Government’s grant for Strategic Research Areas – Care Sciences and co-funded by the University of Gothenburg, Sweden), and The Healthcare Board, Region Västra Götaland (Hälso- och sjukvårdsstyrelsen), Sweden. This research was undertaking, in part, thanks to funds from the Canada Research Chairs (CRC) program supporting Dr. Sawatzky’s CRC in Person-Centered Outcomes.