Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-text Comments from a Postoperative Survey (Preprint)

BACKGROUND Qualitative experience data can inform healthcare providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide healthcare quality improvement: positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement. OBJECTIVE To understand families’ perspectives regarding their child’s surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing postoperative outcomes risk stratification model. METHODS Participants were parents/guardians of children aged 0-18 who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. English second language participants were offered translational services during the consent process and were included if any family member could translate the surveys to their preferred language. Participants were ineligible if they and their families could not understand English or their child had a neurodevelopmental disability. Perioperative survey data were collected from families using the Research Electronic Data Capture tool, including one preoperative survey and follow-up surveys sent on postoperative day (POD) 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until POD 90 was reached. Follow-up surveys included opportunities to leave free-text comments on their child’s surgical experience. Thematic content analysis of free-text comments was completed using NVivo, and quantitative analysis was performed using R. RESULTS In total, 454/500 (91%) enrolled families completed at least one postoperative survey; 242/454 (53%) provided at least one free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient's age distribution was bimodal (modes at 2-3 and 14-15 years), with 160 (66%) being male. Patients underwent orthopedic (24%), urology (16%), general (15%), otolaryngology (13%), ophthalmology (13%), dental (11%), and plastic (7%) surgeries. Largely positive comments (398/485; 82%) were made on the recovery and clinical care experience. A key theme for improvement included “communication,” with subthemes highlighting parental concerns regarding the “preoperative discussions,” “clarity of discharge instructions,” and “continuity of care.” Other themes included “length of stay” and “recovery experience.” Feedback also suggested survey design amendments for future iterations of this instrument. CONCLUSIONS Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between healthcare providers and parents to align expectations and support proactive family-centred care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous QI initiatives involving near-real-time patient feedback to improve the healthcare experience of patients and families.