Patient-Reported Experiences in Vascular Surgery: A Qualitative Analysis of Care Quality

Participants

Using proportional random sampling, 17 patients were selected from 3 vascular units across Wales, ensuring representation of diverse patient experiences. Selection was stratified to achieve a balance in age, gender, and clinical background. Specifically, we included a mix of emergency and elective admissions, as well as patients with different vascular conditions, including peripheral vascular disease, aortic disease, carotid pathology, and iatrogenic vascular injuries requiring surgical intervention. The sampling approach aimed to reflect real-world variations in patient experiences while ensuring coverage of key subgroups within vascular care. Inclusion criteria required adults (aged 18 or over) who had undergone a vascular procedure or inpatient care within the past 3 months, were cognitively able, provided informed consent, and could speak/read English or Welsh. All participants in this study, including those who underwent endovascular revascularization, were required to have a minimum of 24 hours of inpatient care. This criterion was set to ensure comprehensive capture of post-procedure experiences, including pain management, early complications, and transition to post-discharge care. Patients with iatrogenic vascular injuries were included if their definitive management was under the vascular surgery service, ensuring that the focus remained on their experience of vascular care rather than their primary surgical indication.

Data Collection

Data collection took place from June to September 2024, shortly after each patient’s discharge. In-person interviews were prioritised to build rapport, with virtual and phone options available if preferred. Interviews lasted 30 to 60 minutes, guided by a structured tool (Supplemental Document S2) covering communication, decision-making, psychological support, and continuity of care. The guide was informed by a systematic review of surgical PREMs and qualitative studies. ¹² All interviews were conducted by MD, a female vascular surgery trainee with qualitative research experience, who had no prior relationships with participants to minimise bias. MD arranged each interview after initial contact by principal investigators (KA, SJ, DCB) and provided an overview of the study aims. All participants consented and completed the study.

Interviews were conducted at a location chosen for participant convenience, with all individuals opting for their treating hospital as the preferred setting. Each interview occurred in a private hospital room with only MD and the participant present, ensuring confidentiality. Each session concluded with MD taking field notes on non-verbal cues and observations to inform thematic analysis. Data collection continued until thematic saturation was achieved. Audio recordings, with participant consent, were transcribed in an intelligent verbatim format ¹⁴ and anonymised to protect confidentiality.

Data Analysis

Qualitative Data Analysis

The 17 interviews followed an iterative thematic development process, progressing from simpler to more complex experiences until reaching thematic saturation. Early interviews provided foundational insights into patient satisfaction with communication, decision-making, and healthcare processes, introducing themes of patient autonomy and setting the stage for deeper exploration.

In line with established qualitative research methodologies, sample size was determined based on thematic saturation rather than statistical power calculations. Data collection continued until no new themes emerged, ensuring a comprehensive representation of patient experiences. The final sample size of 17 participants aligns with existing qualitative research standards, where saturation is typically reached within 12 to 20 interviews in focused healthcare studies.^15,18

Themes were validated through member checking, with participants reviewing transcripts for accuracy. Discrepancies were incorporated, and research team discussions ensured consistency in theme development.

Communication and Information Delivery

The most pervasive theme across the interviews was the critical role of clear, timely, and consistent communication between patients and healthcare professionals. Participants provided numerous accounts illustrating the significance of clear communication, often contrasting positive experiences with those involving lapses. For instance, Participant P1 emphasised the thoroughness of explanations provided by his surgical team:

They explained everything like, ‘we will do this scan for this reason, then discuss it in a meeting.’ Right the way through, they kept me informed.

Such detailed communication appeared to be highly valued, as it allowed patients to better understand their treatment trajectory and manage their expectations.

Conversely, instances of insufficient communication were often cited as sources of distress.

P5 shared their frustration with receiving conflicting information from different doctors:

I was told by one doctor that I might lose my leg, and another came in later saying the chances were low. It was a relief, but why couldn’t they have told me this in the first place? It was like getting two completely different stories in a matter of days.

Similarly, P3 emphasised the lack of proactive communication during their hospital stay:

I sat there for four days waiting for an update. No one would tell me what was going on. It’s frustrating when you have to keep asking for information.

These sentiments underscore the importance of communication in reducing patient anxiety and enhancing trust in the medical team. During the study period, communication with patients about their treatment and care was primarily conducted through verbal consultations, supplemented by written patient information leaflets on specific vascular conditions and procedures. However, as our findings indicate, the consistency and delivery of this information varied across units.

Patient Involvement in Decision-Making

Patient perspectives varied on involvement in treatment decisions. P7 felt pressured into surgery without options, stating:

I wasn’t given any real options. . . I wanted more time to understand.

In contrast, P13 and P17, who underwent elective surgery, appreciated the choice and time to ask questions, highlighting the importance of shared decision-making for all patients:

P13: They explained everything clearly and gave me time to ask questions. I knew what my options were, and that helped me feel more in control of my treatment.

P17: My doctor was brilliant; he didn’t rush me into anything. He laid everything in front of me and my husband, he gave me time to ask questions, and I felt like my concerns were heard. . . I felt confident and I trusted him.

This contrast highlights the varying degrees of patient involvement, with a clear need for providing adequate information and shared decision-making opportunities across all cases, whether elective or urgent.

Pain Management

Pain management was a crucial aspect of patient well-being, affecting both physical and emotional health. Participants reported mixed experiences, with timely interventions often cited as critical. P7 expressed frustration with delayed postoperative pain control:

After my surgery, the pain was intense. I felt like I was begging. . . it was really hard to cope.

Similarly, P9 noted challenges with chronic pain, feeling misunderstood:

I deal with pain all the time. . . it’s exhausting, and sometimes I feel like the doctors just don’t understand.

Positive experiences were also shared, especially when healthcare providers were proactive. P17 found patient-controlled analgesia (PCA) empowering:

They started me on a button analgesia pump. . . it helped a lot.

PCA allowed patients control over their pain management, enhancing recovery. Additionally, P15 highlighted the importance of attentive staff:

The nurses checked in on my pain levels regularly. . . that made a big difference.

These accounts underscore the impact of patient-centred, responsive pain management strategies.

Psychological and Emotional Support

Participants reported mixed experiences with emotional support. Some, like P8, appreciated providers’ empathy:

They were incredibly kind. . . it made all the difference.

Such encounters underscored the positive impact of emotional support on reducing anxiety. Others highlighted the emotional toll of unmanaged pain, emphasising a need for holistic approaches. P16 shared:

It’s not just physical pain; it weighs on your mind too. . . I wish there was more support.

The absence of mental health support during stressful periods was a common frustration. P2 and P3 expressed feeling isolated, with P2 stating:

No one asked if I wanted to speak to someone. . . it would have made a huge difference,

while P3 struggled with the emotional burden of uncommunicated risks:

I didn’t want to worry my wife, but I was scared. . . I couldn’t sleep for days.

These reflections indicate a potential need for integrating psychological support into patient care, especially in high-risk situations, alongside accessible, clear information. Notably, none of the participants in our study reported utilising such services, underscoring a potential gap in available psychological support for vascular patients.

Healthcare Environmental and Systemic Processes

The physical environment, especially cleanliness, was frequently linked to feelings of safety. P9 appreciated this, noting:

Everything was spotless, which made me feel safe.

However, issues like noise and lack of privacy in shared wards detracted from patient comfort. P6 remarked:

It was hard to sleep with all the noise. . . I felt like I had no privacy.

These experiences point to areas for improvement in the hospital environment.

Systemic issues, such as staffing, scheduling, and waiting times, were common frustrations. Although some delays were unavoidable, patients felt that better communication could alleviate related stress. P3 shared:

I knew I’d have to wait, but I just wanted someone to tell me what was going on.

This highlights the role of communication in managing patient anxiety even when operational constraints persist.

Logistical efficiency also influenced satisfaction, with P17 valuing streamlined follow-ups:

They tried to schedule things so I wouldn’t have to keep coming back.

Similarly, continuity of care was affected by disjointed communication across departments. P12 noted:

Every time I saw a different doctor, I had to repeat my story. . . it felt like my care was just being passed around.

Such insights underscore the impact of both environmental and systemic factors on patient experience, with communication as a key factor in mitigating these stresses

Continuity of Care and Post-Discharge Experience

While some vascular procedures, such as endovascular revascularization, are performed as day-case interventions in select centres, all patients in this study were admitted for at least 24 hours, as per national policy. This standard ensured that key aspects of early recovery, including access-site management, pain control, and observation for immediate complications, were consistent across participants.

Well-coordinated follow-up care was vital for patients’ recovery, providing reassurance and support. P13 commented:

Knowing I had follow-ups scheduled helped me feel more secure about my recovery.

This feeling of reassurance was common among those with clear post-operative guidance. However, some participants experienced challenges, particularly during transitions from hospital to home. Insufficient information on post-discharge care left some feeling unprepared and administrative issues complicated continuity for some, as P1 shared:

My medical records didn’t transfer properly. . . I had to commute back to England for my appointments.

Also, P10 described feeling rushed at discharge:

It would be beneficial to have a more structured follow-up. . . I had many questions.

These accounts underscore the importance of clear communication and proactive outreach during discharge, ensuring patients are well-equipped to manage their recovery and addressing any lingering concerns.

The findings highlighted communication, patient involvement in decision-making, psychological support, environmental and logistical support, and continuity of care as core components of the vascular patient experience. These themes are interconnected, with communication as the foundation influencing other areas. Effective communication facilitated decision-making, enhanced psychological support, and improved continuity of care, helping to reduce patient distress and foster trust in providers. Positive experiences arose when communication was clear and patients felt involved, while inconsistent information and limited support often led to negative experiences. These interrelations, with communication at its core, is illustrated in Figure 1

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Figure 1.

Interconnected themes of the vascular patient experience.

Strengths

This study provides valuable insights into the experiences of vascular patients, an area with limited prior qualitative research, especially in the context of developing a PREM. Few studies have explored this aspect of vascular care, making our findings a crucial addition to the patient-centred care knowledge base within this specialty. Through in-depth interviews, we captured detailed patient perspectives that may guide improvements in vascular healthcare delivery. Consistency in data collection was maintained by having a single interviewer conduct all interviews, and conducting interviews shortly after discharge minimised recall bias, thereby enhancing data accuracy.

Limitations

There are key limitations that should be acknowledged in the context of this qualitative study. While developing condition-specific PREMs for each vascular pathology (eg, peripheral vascular disease, aortic disease, carotid disease) may offer more targeted insights, such an approach is resource-intensive and may limit widespread implementation. Each condition-specific PREM would require separate research, psychometric validation, and rollout. Although our study identified common experiential themes across diagnoses, further research could explore whether modular or adaptable PREMs might better accommodate condition-specific nuances, including variations in preoperative symptom burden or urgency of presentation.

The inclusion of patients with iatrogenic vascular injuries may have introduced some variability, as their original surgical indication might influence perceptions of care. However, our analysis focused specifically on their experience under vascular teams, and their thematic responses were consistent with the broader cohort, particularly in domains such as communication, decision-making, and continuity of care. Further exploration of this subgroup could reveal whether distinct concerns warrant targeted evaluation. This study was conducted across vascular centres in Wales, which operate within a nationally coordinated network. While this structure provides consistency in care pathways, it may limit generalisability to other healthcare systems with different governance, funding, or service delivery models. Moreover, only English- and Welsh-speaking participants were included, potentially excluding perspectives from linguistically diverse populations.

Our sample included only inpatients with a minimum stay of 24 hours, thereby excluding day-case procedures, outpatient experiences, and patients managed conservatively. This criterion allowed in-depth exploration of perioperative care but may not reflect the full range of vascular experiences. Interviews were also limited to patients; input from family members or carers, who often play critical roles in decision-making and post-discharge support, was not captured.

Finally, data collection occurred between June and September 2024. Although vascular services operate continuously, we cannot exclude the potential influence of seasonal variations on hospital processes or patient experiences. These limitations highlight opportunities for further research to explore patient perspectives across outpatient settings, non-English-speaking populations, and international healthcare systems, and to determine the potential value of condition-specific or modular PREM frameworks.