Self-management therapeutic guidelines of pain and surgical wound after hospital discharge: a Scoping Review
DOI:
https://doi.org/10.31877/on.2023.47.06Keywords:
self-management, postoperative period, pain, surgical wound, surgical oncologyAbstract
Purpose: Since pain and symptoms related to the surgical wound are common in the postoperative period, it is essential to know about interventions to enable the patient to self-manage these symptoms. Objective: This review aimed to identify therapeutic guidelines to support the self-management of pain symptoms and those related to the surgical wound in people with oncological disease undergoing surgery, after clinical discharge. Methods: This review was guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) model for organizing information. The search strategy included studies in CINAHL and MEDLINE, via EBSCOhost. Results: The search identified 302 publications, from these, 8 studies were selected for pain and 4 for symptoms related to the surgical wound. Nonpharmacological interventions were the most frequently described and included physical and psychosocial interventions, related to pain. With regard to the surgical wound, interventions to monitor signs and symptoms indicative of infection are highlighted. Conclusions: Evidence indicates that postoperative pain control may benefit when pharmacological interventions are complemented with nonpharmacological interventions. Training for self-monitoring of the surgical wound, namely the early detection of signs of infection, is the main promoter for selfmanagement.
keywords: self-management; postoperative period; pain; surgical wound; surgical oncology
Downloads
References
Grady PA, Gough LL. Self-management: A comprehensive approach to management of chronic conditions. Am. J. Public Health. 2018;108: S430–S6. https://doi.org/10.2105/AJPH.2014.302041
Rosland AM, Heisler M, Piette JD. The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J Behav Med. 2012;35(2):221-39.
https://doi.org/10.1007/s10865-011-9354-4
Holman H, Lorig, K. Patient Self-Management : A Key to Effectiveness and Efficiency in Care of Chronic Disease in Care to Effectiveness of Chronic Disease. Public Health Rep. 2004;119:239-43. https://doi.org/doi: 10.1016/j.phr.2004.04.002
Pizzoli SFM, Renzi C, Arnaboldi P, Russell-Edu W, Pravettoni G, Monacis L. From life-threatening to chronic disease: Is this the case of cancers? A systematic review. Cogent Psychol. 2019;6(1).
https://doi.org/10.1080/23311908.2019.1577593
Talboom-Kamp EPWA, Verdijk NA, Kasteleyn MJ, Numans ME, Chavannes NH. From chronic disease management to person-centered eHealth; a review on the necessity for blended care. Clinical eHealth. 2018;1(1):3-7. https://doi.org/10.1016/j.ceh.2018.01.001
Saúde SNd. SNS+ Proximidade - Mudança centrada nas pessoas. 2018.
Odom-Forren J, Wesmiller S. Managing Symptoms: Enhancing Patients Self-Management Knowledge and Skills for Surgical Recovery. Semin Oncol Nurs. 2017;33(1):52-60.
https://doi.org/10.1016/j.soncn.2016.11.005
Avery KNL, Richards HS, Portal A, Reed T, Harding R, Carter R, et al. Developing a real-time electronic symptom monitoring system for patients after discharge following cancer-related surgery. BMC
Cancer. 2019;19(1). https://doi.org/10.1186/s12885-019-5657-6
Richards HS, Portal A, Absolom K, Blazeby JM, Velikova G, Avery KNL. Patient experiences of an electronic PRO tailored feedback system for symptom management following upper gastrointestinal
cancer surgery. Qual Life Res. 2020. https://doi.org/10.1007/s11136-020-02539-w
Cata JP, Corrales G, Speer B, Owusu-Agyemang P. Postoperative acute pain challenges in patients with cancer. Best Pract Res Clin Anaesthesiol. 2019;33(3):361-71.
https://doi.org/10.1016/j.bpa.2019.07.018
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet. 2006;367(9522):1618-25. https://doi.org/10.1016/s0140-6736(06)68700-x
Shipton EA. The transition from acute to chronic post surgical pain. Anaesth Intensive Care. 2011;39:824-36.
Park R, Mohiuddin M, Arellano R, Pogatzki-Zahn E, Klar G, Gilron I. Prevalence of Postoperative Pain Following Hospital Discharge: Protocol for a Systematic Review. JMIR Res Protoc. 2020;9(12):e22437. https://doi.org/10.2196/22437
Baratta JL, Schwenk ES, Viscusi ER. Clinical consequences of inadequate pain relief: barriers to optimal pain management. Plast Reconstr Surg. 2014;134(4 Suppl 2):15S-21S.
https://doi.org/10.1097/PRS.0000000000000681
Pfail JL, Garden EB, Gul Z, Katims AB, Rosenzweig SJ, Razdan S, et al. Implementation of a nonopioid protocol following robot-assisted radical cystectomy with intracorporeal urinary diversion.
Urol Oncol. 2021;39(7):436.e9-.e16. https://doi.org/10.1016/j.urolonc.2021.01.002
Jacobs BL, Rogers D, Yabes JG, Bandari J, Ayyash OM, Maganty A, et al. Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery. Cancer.
;127(2):257-65. https://doi.org/10.1002/cncr.33200
Higgins TM, Pham M, McDonald J, Le Neveu M, Haslett W, Erekson E, et al. The Effect of State Legislation on Opioid Prescribing Practices Foll owing Gynecologic Surgery. J Gynecol Surg.
;37(4):291-6. https://doi.org/10.1089/gyn.2020.0139
Gunasingha RMKD, Niloy IL, Wetstein BB, Learn PA, Turza LC. Keeping tabs: Reducing postoperative opioid prescriptions for patients after breast surgical procedures. Surgery. 2021;169(6):1316-22. https://doi.org/10.1016/j.surg.2020.11.045
Odom-Forren J, Wesmiller S. Managing Symptoms: Enhancing Patients Self-Management Knowledge and Skills for Surgical Recovery. Semin Oncol Nurs. 2017;33(1):52-60. https://doi.org/10.1016/j.soncn.2016.11.005
Small C, Laycock H. Acute postoperative pain management. Br J Surg. 2020;107(2):e70-e80. https://doi.org/10.1002/bjs.1147
DGS. “Feixe de Intervenções” para a Prevenção da Infeção do Local Cirúrgico. In: DGS, editor. dqs@dgs.min-saude.pt2022.
DGS. Prevenção da Infeção do Local Cirúrgico. dqs@dgs.minsaude.pt2013.
Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. J Hosp Infect. 2009;72(3):243-50.
https://doi.org/10.1016/j.jhin.2009.03.021
Macefield R, Richards HS, Avery KNL, Portal A, Harding R, Reed T, et al. A hospital-integrated symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery. Trials. 2019;20. https://doi.org/10.1186/s13063-019-3688-6
Anaya DA, Cormier JN, Xing Y, Koller P, Gaido L, Hadfield D, et al. Development and validation of a novel stratification tool for identifying cancer patients at increased risk of surgical site infection. Ann Surg. 2012;255(1):134-9. https://doi.org/10.1097/SLA.0b013e31823dc107
Hari M, Rosenzweig M. Incidence of preventable postoperative readmissions following pancreaticoduodenectomy: implications for patient education. Oncol Nurs Forum. 2012;39(4):408-12. https://doi.org/10.1188/12.ONF.408-412
Shah M, Douglas J, Carey R, Daftari M, Smink T, Paisley A, et al. Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program. Ann Otol Rhinol Laryngol. 2021;130(1):24-31. https://doi.org/10.1177/0003489420937044
Petherick ES, Dalton JE, Moore PJ, Cullum N. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infect Dis. 2006;6:170. https://doi.org/10.1186/1471-2334-6-170
Macefield RC, Reeves BC, Milne TK, Nicholson A, Blencowe NS, Calvert M, et al. Development of a single, practical measure of surgical site infection (SSI) for patient report or observer completion. J Infect Prev. 2017;18(4):170-9. https://doi.org/10.1177/1757177416689724
Peters M.D.J, Godfrey C, McInerney P, Munn Z, Tricco A.C, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E MZE, editor. JBI Reviewer’s Manual, JBI, 20202020.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
https://doi.org/10.1136/bmj.n71
Trotter PB, Norton LA, Loo AS, Munn JI, Voge E, Ah-See KW, et al. Pharmacological and other interventions for head and neck cancer pain: a systematic review. J Oral Maxillofac Surg. 2013;3(4):e1.
https://doi.org/10.5037/jomr.2012.3401
Tola YO, Chow KM, Liang W. Effects of non-pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review.
J Clin Nurs. 2021;30(23-24):3369-84. https://doi.org/10.1111/jocn.15827
Hill BL, Lefkowits C. Strategies for Optimizing Perioperative Pain Management for the Cancer Patient. Surg Oncol Clin N Am. 2021;30(3):519-34. https://doi.org/0.1016/j.soc.2021.02.011
Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd K, Paice JA, et al. American Pain Society Recommendations for Improving the Quality of Acute and Cancer Pain Management. Arch Intern Med. 2005;165:1574-80. https://doi.org/10.1001/archinte.165.14.1574
Swarm RA, Paice JA, Anghelescu DL, Are M, Bruce JY, Buga S, et al. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019;17(8):977-
https://doi.org/10.6004/jnccn.2019.0038
British Columbia Cancer Agency. Symptom Management Guidelines:PAIN. 2018 [Available from: http://www.bccancer.bc.ca/managing-symptoms-site/Documents/Pain-from-Cancer.pdf.
National Cancer Institute. Cancer Pain Control: Support for People With Cancer. 2019. [Available from: https://www.cancer.gov/publications/patient-education/pain-control]
American Society. Scars and Wounds. 2020. [Available from:
Cancer research UK . Surgery for cancer - Going home after surgery. 2019 [Available from: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/surgery/long-term-problems]
Cancer Council Australia. Understanding Surgery. A guide for people with cancer, their families and friends 2019. [Available from:https://www.cancer.org.au/assets/pdf/understanding-surgery-booklet]
Nallani R, Fox CC, Sykes KJ, Surprise JK, Fox CE, Reschke AD, et al. Pain Management and Education for Ambulatory Surgery: A Qualitative Study of Perioperative Nurses. J Surg Res. 2021;260:419-27. https://doi.org/10.1016/j.jss.2020.11.001
Mitchell M. Home recovery following day surgery: a patient perspective. Journal of clinical nursing. 2015;24(3-4):415-27. https://doi.org/10.1111/jocn.12615
Chaparro-Diaz L, Rojas MZ, Carreño-Moreno SP. Optimising postoperative discharge plans for patients undergoing surgical treatment for gastric cancer: a literature review. Gastroenterol
Nurs. 2021;19(1):34-40. https://doi.org/10.12968/gasn.2021.19.1.34
Harrison JD, Young JM, Auld S, Masya L, Solomon MJ, Butow PN. Quantifying postdischarge unmet supportive care needs of people with colorectal cancer: a clinical audit. Colorectal Dis. 2011;13(12):1400-6. https://doi.org/10.1111/j.1463-1318.2010.02478.x
Patil JD, Sefen JAN, Fredericks S. Exploring Non-pharmacological Methods for Pre-operative Pain Management. Front Surg. 2022;9:801742. https://doi.org/10.3389/fsurg.2022.801742
Boitano TKL, Sanders LJ, Gentry ZL, Smith HJ, Leath CA, Xhaja A, et al. Decreasing opioid use in postoperative gynecologic oncology patients through a restrictive opioid prescribing algorithm. Gynecol Oncol. 2020;159(3):773-7. https://doi.org/10.1016/j.ygyno.2020.09.014
Choi KS, Jeong YM, Lee E, Kim KI, Yee J, Lee BK, et al. Association of pre-operative medication use with post-surgery mortality and morbidity in oncology patients receiving comprehensive geriatric
assessment. Aging Clin Exp Res. 2018;30(10):1177-85. https://doi.org/10.1007/s40520-018-0904-2
Ellis JL, Ghiraldi EM, Cohn JA, Nitti M, Friedlander JI, Ginzburg S, et al. Prescribing Trends in Post-operative Pain Management After Urologic Surgery: A Quality Care Investigation for Healthcare
Providers. Urology. 2021;153:156-63. https://doi.org/10.1016/j.urology.2020.11.070
Fearon NJ, Benfante N, Assel M, Chesnut GT, Vickers A, Levine M, et al. Standardizing Opioid Prescriptions to Patients After Ambulatory Oncologic Surgery Reduces Overprescription. Jt Comm
J Qual Patient Saf. 2020;46(7):410-6. https://doi.org/10.1016/j.jcjq.2020.04.004
Glaser GE, Kalogera E, Kumar A, Yi J, Destephano C, Ubl D, et al. Outcomes and patient perspectives following implementation of tiered opioid prescription guidelines in gynecologic surgery.
Gynecol Oncol. 2020;157(2):476-81. https://doi.org/10.1016/j.ygyno.2020.02.025
Kay AH, Venn M, Urban R, Gray HJ, Goff B. Postoperative narcotic use in patients with ovarian cancer on an Enhanced Recovery After Surgery (ERAS) pathway. Gynecol Oncol. 2020;156(3):624-8.
https://doi.org/10.1016/j.ygyno.2019.12.018
Ruano A, Garcia-Torres F, Galvez-Lara M, Moriana JA. Psychological and Non-Pharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis. J Pain Symptom
Manage. 2022;63(5):e505-e20. https://doi.org/10.1016/j.jpainsymman.2021.12.021
Mohamed Bayoumi MM, Khonji LMA, Gabr WFM. Are nurses utilizing the non-pharmacological pain management techniques in surgical wards? PLoS One. 2021;16(10):e0258668.
https://doi.org/10.1371/journal.pone.0258668
Chan EY, Blyth FM, Nairn L, Fransen M. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthr Cartil. 2013;21(9):1257-63. https://doi.org/10.1016/j.joca.2013.06.011
Fan M, Chen Z. A systematic review of non-pharmacological interventions used for pain relief after orthopedic surgical procedures. Exp Ther Med. 2020;20(5):36. https://doi.org/10.3892/etm.2020.9163
Sarmento S, Santos K, Dantas J, Silva B, Dantas D, Dantas R. Terapias não farmacológicas no alívio da dor pós-operatória de cirurgias cardíacas: revisão de escopo. Online Braz J Nurs. 2021.
https://doi.org/10.17665/1676-4285.20216494
Clarke HA, Manoo V, Pearsall EA, Goel A, Feinberg A, Weinrib A, et al. Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery. Can J Pain. 2020;4(1):67-85. https://doi.org/10.1080/24740527.2020.1724775
Burhenn P, Olausson J, Villegas G, Kravits K. Guided imagery for pain control. Clin J Oncol Nurs. 2014;18(5):501-3. https://doi.org/10.1188/14.CJON.501-503
Topcu SY, Findik UY. Effect of relaxation exercises on controlling postoperative pain. Pain Manag Nurs. 2012;13(1):11-7. https://doi.org/10.1016/j.pmn.2010.07.006
Engwall M, Duppils GS. Music as a nursing intervention for postoperative pain: a systematic review. J Perianesth Nurs. 2009;24(6):370-83. https://doi.org/10.1016/j.jopan.2009.10.013
Watkins AA, Johnson TV, Shrewsberry AB, Nourparvar P, Madni T, Watkins CJ, et al. Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial. J Am Coll Surg. 2014;219(3):511-7. https://doi.org/10.1016/j.jamcollsurg.2014.03.057
Komann M, Weinmann C, Schwenkglenks M, Meissner W. Non-Pharmacological Methods and Post-Operative Pain Relief: An Observational Study. Anesth Pain Med. 2019;9(2):e84674.
https://doi.org/10.5812/aapm.84674
Veal FC, Thompson AJ, Perry LJ, Bereznicki LR, Peterson GM. Pain intensity and pain self-management strategies following discharge after surgery: An Australian prospective observational study. J Clin Pharm Ther. 2018;43(1):8-14. https://doi.org/10.1111/jcpt.12584
Pieper B, Sieggreen M, Nordstrom CK, Freeland B, Kulwicki P, Frattaroli M, et al. Discharge Knowledge and Concerns of Patients Going Home With a Wound. J Wound Ostomy Continence
Nurs. 2007;34:245-53. https://doi.org/doi:10.1097/01.won.0000270817.06942.00
Kirkland-Kyhn H, Generao SA, Teleten O, Young HM. Teaching Wound Care to Family Caregivers. Am J Nurs. 2018;118:63-7. https://doi.org/doi:10.1097/01.NAJ.0000530941.11737.1c
Senn B, Mueller MD, Hasenburg A, Blankenstein T, Kammermann B, Hartmann A, et al. Development of a Postsurgical PatientReported Outcome Instrument for Women With Vulvar Neoplasia.
Oncol Nurs Forum. 2012;39(6):E489-E98. https://doi.org/10.1188/12.ONF.E489-E498
Fernandes CS, Magalhães B, Santos C, Galiano JMM. IGestSaúde a mobile application for the self-management of symptoms associated with chemotherapy treatment: Development protocol.
Nurs Pract Today. 2021;8:X-X. https://doi.org/10.18502/npt.v8i2.5126
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Ana Maria Almeida, Teresa Martins, Lígia Lima
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
(CINAHL Ultimate database)
