Patient Education Materials from a person-centred perspective – Coping and co-design in colorectal cancer care

To cope with possible stressful events after colorectal cancer surgery, patients need to be prepared for the early postoperative phase. Complementary written information is often used, but requires improvement. The overall aim for this thesis was to describe patient reported stressful events and coping strategies and with a person-centred approach characterize existing and co-design new patient education materials for patients undergoing colorectal cancer surgery. Situational coping reported by 105 patients 4-6 weeks after colorectal cancer surgery were described in study I by using the Daily coping assessment instrument. Self reported stressful events along with coping strategies used and if considered helpful or not were analysed from 523 diary entries. In study II, 125 Patient Education Materials from 27 hospitals in Sweden were examined for readability, suitability and comprehensibility with a mixed method design. Using a validated instrument revealed that 44 % of the discharge information was not suitable. Language technology measures showed that up to 29 % of materials were difficult to understand. Analysis of five focus groups with 15 patients revealed additional areas to be included in new materials. A new Patient Education Material was developed with stakeholders (patients, professionals and researchers) using a participatory methodology design. In study III, negotiations derived by areas of tensions were reflected on and presented. Main tensions were related to power structures. Parallel to this, in study IV, principles on how to design Patient Education Materials by combining the dimensions of 1, 2 and 3 person described in Action research as voice and in Ricoeur ́s philosophy as self were developed from a theoretical analysis. As a whole, the thesis is built upon the principles of first, second and third person perspective used as a philosophical and theoretical basis to present a workable example in a practical setting. The results can benefit both patients and other relevant stakeholders in the healthcare system in developing written patient education materials.