Qualitative Assessment of Outcomes Following Ventral Hernia Repair: Implications for Clinical Research
Martin J. Carney, III, B.S., Jason M. Weissler, M.D., Kate Golden, M.A., Michael A. Lanni, B.S., Andrew R. Bauder, M.D., Frances K. Barg, Ph.D., John P. Fischer, M.D., M.P.H..
University of Pennsylvania, PHILADELPHIA, PA, USA.
PURPOSE: Ventral hernia (VH) remains an inadequately addressed surgical problem. While advanced repair techniques have been the focus of the surgical community, patient reported outcome (PRO) measures are needed to ensure that the perspective of patients, being key stakeholders in hernia research, is included. Current hernia PRO measures were developed without patient input, greatly impairing the content validity of such instruments.
METHODS: This cross-sectional, qualitative study examined the alignment of patient perceptions of VH repair to a conceptual hernia PRO framework using semi-structured, concept elicitation interviews of VH repair, recovery and satisfaction until saturation was reached. Thematic analysis using iterative methodologies, e.g. open coding and simultaneous data collection and analysis led to the revision of domains. Reliability and validation checks included inter-rater reliability using Cohen’s kappa statistic (mean kappa = .99), member-checking and triangulation.
RESULTS: Interviews with 15 patients revealed that the original hernia PRO conceptual framework aligned with the domains relevant to VH patients but required modification to represent the depth and range of patients’ perceived experiences. The revised framework included seven domains: 1) Expectations, 2) Self and Others, 3) Surgeon and Surgical Team, 4) Sensation, 5) Function, 6) Appearance, and 7) Overall Satisfaction. Overall patient satisfaction was associated with two themes: 1) Provider-patient relationship and 2) Patient assessment of post-repair quality of life.
CONCLUSION: While surgeons and patients share many goals regarding VH repair, key aspects of what matters most to patients has not been included in current VH PRO instruments.
Back to 2017 Program