The UCLA PEACE (Perioperative Education and Clinical Evaluation)
program educates patients and prepares them for surgery, helping them take more control of their preoperative, intra-operative and postoperative care in order to achieve better outcomes. The program is currently available to esophageal cancer patients preparing for thoracic surgery, and there are plans to expand it to a wider group of thoracic surgery patients in the near future. Members of the PEACE program staff work with patients prior to surgery to help them ready themselves physically and emotionally. This preparation helps to ease anxiety, which can affect the surgical outcome.
The ABCs of PEACE
Pulmonary. Respiratory training can help esophageal cancer patients achieve better postoperative results. The use of incentive spirometry aids recovery and helps prevent pneumonia. Patients are introduced to this device prior to surgery so that postoperatively they are familiar with the technique and have preset goals. Pain. Patients are counseled prior to surgery on what to expect in terms of pain and what to do if they have postoperative pain.
Eating. Patients are advised on appropriate preoperative nutrition, including medically desirable weight loss or gain. Program staff explain any special postoperative dietary needs — such as a liquid diet — so patients are not surprised by these requirements.
Activity. A twice-daily preoperative walking program helps condition patients for the operating room. In addition, program staff prepare patients by presenting them with a schedule of postoperative milestones. This helps patients stay on schedule with their recovery and reduces their anxiety about what to expect.
Care of tubes, drains and dressings. The program advises patients on their likely postoperative need for tubes — including feeding tubes and drains — to help minimize the anxiety these can cause after surgery. Before discharge, patients are shown how to use and care for their feeding tubes, drains and surgical wounds.
Emotions. Program staff help patients prepare emotionally for their upcoming surgery by offering information, answering questions and even putting them in contact with other patients who have had similar procedures. Patients who find comfort in spiritual or meditative practices are encouraged to use them to help ready themselves for the surgery and the recovery process.
Reduced anxiety
UCLA’s experience with the program thus far indicates that preparing patients prior to surgery significantly reduces patients anxiety. The patients themselves report that they feel better prepared and less anxious than they have for other surgeries. Preparing patients in this manner frees them to focus on their recovery rather than dealing with negative reactions to things happening to them that they do not understand.
Advance preparation promotes recovery
“Stress inhibits healing and slows recovery,” says Mary Maish, M.D., MPH, director of the UCLA Center for Esophageal Disorders. “Patients who are more informed and have a better understanding of what to expect tend to do better.” The PEACE program at UCLA begins prior to surgery, preparing patients for both the surgery and the recovery process. The program continues postoperatively, helping patients with various aspects of their recovery and preparing them to continue their healing at home. In addition to providing guidance on practical considerations, including diet and activity, the program helps reduce patients’ anxiety about their surgery and recovery. According to Dr. Maish, “The PEACE program helps give patients peace of mind.”
Physicians
Mary Maish, M.D., MPH Assistant Professor of Surgery
Division of Cardiothoracic Surgery
Director, UCLA Center for Esophageal Disorders
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The UCLA PEACE (Perioperative Education and Clinical Evaluation) 
