Enhanced Recovery After Surgery (ERAS®) multimodal programme as experienced by pancreatic surgery patients: Findings from an Italian qualitative study

Background: ERAS® has recently been implemented in pancreatic surgery settings, but there is little evidence regarding the effects as perceived by patients. Given the lack of the knowledge in the field, the aim of this study was to capture the experience of patients undergoing pancreatic surgery who received perioperative care based on the ERAS® programme. Methods: We designed a qualitative study undertaken in the pancreatic surgery unit of San Raffaele Hospital in Milan, Italy. Twenty-two consecutive patients were invited to participate in the study and 13 patients were interviewed. Data was collected between March and December 2012 either through face-to-face or semi-structured telephone follow-up from three to six weeks after discharge. Data was analysed using the interpretative phenomenological approach. Results: Patients who underwent surgical pancreatic procedures and treated with ERAS® programme reported experiences based on four themes: (1) Feeling prepared to face surgery, (2) Being actively "inside" or "outside" the programme, (3) Healing at home: the best setting, and (4) "Perceiving the ordinary as extraordinary": reaching independence, once at home. Conclusion: According to the findings, uncomplicated pancreatic surgery patients may benefit from the ERAS® programme. Preadmission counselling should help patients to assume an active role. Once the patient returns home, the availability of a caregiver should be thoroughly assessed to guarantee the support needed by patients to successfully complete the ERAS® programme. Surgery and nursing staffshould carefully monitor patients and suggest whether they continue, interrupt, or individualise the scheduled ERAS® interventions in accordance with a patient's clinical condition and preferred personal timing.