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Vol.58 No.1 contents | Japanese/English |
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- Original Article -
The Effects of Preoperative Multi-disciplinary Support Performed at an Outpatient Clinic on Lung Cancer Patients
Masafumi Kataoka1, Daisuke Okutani1, Tamami Okutani2, Tadashi Koizumi3, Toshie Hiramatsu3, Michiyo Kayahara3, Takefumi Niguma1, Haruyuki Kawai4, Kazuhiko Watanabe4, Miwa Baba51Department of Surgery, 2Department of Rehabilitation, 3Department of Nursing, 4Department of Internal Medicine, 5Department of Anesthesiology, Okayama Saiseikai General Hospital, Japan
Objective. We assessed the effects of preoperative multi-disciplinary support performed at the outpatient clinic of our hospital on patients with lung cancer. Methods. Since 2013, coaching on respiratory rehabilitation has been provided to lung cancer patients at our outpatient clinic. In 2014, preoperative multi-disciplinary support was introduced in addition to rehabilitation support. The multi-disciplinary team consisted of an anesthesiologist, a nutritionist, a pharmacist, a medical social worker, and a nurse. We examined 54 cases of primary lung cancer patients undergoing video-assisted lobectomy. Patients were classified into three groups: 'no support'; 'Rehab. alone', and 'Multi-support'. The 'no support' group received no preoperative support and included the final 18 consecutive cases before the introduction of preoperative support. The 'Rehab. alone' group included the 18 consecutive cases encountered when no other support was available. The 'Multi-support' group included 18 consecutive cases starting from the first patient to receive multi-disciplinary preoperative support. Results. Regarding patients receiving 'no support', 'Rehab. alone', and 'Multi-support', the duration of the postoperative hospital stay was 11.3/10, 8.7/8, and 6.9/7 (average/median), respectively, with a significant difference among the groups (p=0.000266). Univariate and multivariate analyses were performed for several parameters. Age, blood loss, days with a fever, postoperative date of initial walking, and preoperative support were associated with a shorter postoperative stay according to a logistic regression analysis with backward stepwise deletion. Preoperative support showed the most significance among these parameters. We also noted a reduction in the overall medical expenses per patient in the preoperative support group compared with the other groups (p=0.0406). The results of a postoperative questionnaire administered to patients and their families showed that patients recognized the effects of preoperative interventions on their outcome, and a shift in the patient attitude from a passive to an active mindset was observed. Conclusion. Preoperative rehabilitation and nutritional support improve the physiological function, a review of general condition by an anesthesiologist and a review of medical history by pharmacist can help identify problems and improve the treatment strategy. In addition, having the nursing staff explain course of the operation can help increase their problem-solving capacity and encourage the coping mechanisms of patients. These effects may result in a shorter hospital stay.
key words: Multi-disciplinary support, Preoperative, Lung cancer, Nursing clinic, Respiratory rehabilitation
Received: February 22, 2017
Accepted: November 15, 2017
JJLC 58 (1): 8-13, 2018
