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Maheta B, Shehabat M, Khalil R, Wen J, Karabala M, Manhas P, Niu A, Goswami C, Frezza E. The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials. JMIR Perioper Med 2024; 7:e51573. [PMID: 38935953 PMCID: PMC11240078 DOI: 10.2196/51573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/10/2023] [Accepted: 05/06/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. OBJECTIVE This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. METHODS In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. RESULTS Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. CONCLUSIONS Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. TRIAL REGISTRATION PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.
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Affiliation(s)
- Bhagvat Maheta
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Mouhamad Shehabat
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Ramy Khalil
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Jimmy Wen
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Muhammad Karabala
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Priya Manhas
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Ashley Niu
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Caroline Goswami
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Eldo Frezza
- California Northstate University College of Medicine, Elk Grove, CA, United States
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Kostick-Quenet KM, Lang B, Dorfman N, Estep J, Mehra MR, Bhimaraj A, Civitello A, Jorde U, Trachtenberg B, Uriel N, Kaplan H, Gilmore-Szott E, Volk R, Kassi M, Blumenthal-Barby JS. Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy. PATIENT EDUCATION AND COUNSELING 2024; 122:108157. [PMID: 38290171 DOI: 10.1016/j.pec.2024.108157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Personalized risk (PR) estimates may enhance clinical decision making and risk communication by providing individualized estimates of patient outcomes. We explored stakeholder attitudes toward the utility, acceptability, usefulness and best-practices for integrating PR estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). METHODS AND RESULTS As part of a 5-year multi-institutional AHRQ project, we conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers), analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards integrating PR in decision making. Patients, caregivers and coordinators emphasized that PR can help to better understand a patient's condition and risks, prepare mentally and logistically for likely outcomes, and meaningfully engage in decision making. Physicians felt it can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups also raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance. CONCLUSION Stakeholders are optimistic about integrating PR into clinical decision making, but acceptability depends on prospectively demonstrating accuracy, relevance and evidence that benefits of PR outweigh potential negative impacts on decision making quality.
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Affiliation(s)
| | - Benjamin Lang
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Natalie Dorfman
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | - Nir Uriel
- Columbia University Irving Medical Center, New York, NY, USA
| | - Holland Kaplan
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Eleanor Gilmore-Szott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Robert Volk
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Hladkowicz E, Auais M, Kidd G, McIsaac DI, Miller J. "It's a stressful, trying time for the caretaker": an interpretive description qualitative study of postoperative transitions in care for older adults with frailty from the perspectives of informal caregivers. BMC Geriatr 2024; 24:246. [PMID: 38468202 DOI: 10.1186/s12877-024-04826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Older adults with frailty have surgery at a high rate. Informal caregivers often support the postoperative transition in care. Despite the growing need for family and caregiver support for this population, little is known about the experience of providing informal care to older adults with frailty during the postoperative transition in care. The purpose of this study was to explore what is important during a postoperative transition in care for older adults with frailty from the perspective of informal caregivers. METHODS This was a qualitative study using an interpretive description methodology. Seven informal caregivers to older adults [aged ≥ 65 years with frailty (Clinical Frailty Scale score ≥ 4) who had an inpatient elective surgery] participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using reflexive thematic analysis. RESULTS Four themes were constructed: (1) being informed about what to expect after surgery; (2) accessible communication with care providers; (3) homecare resources are needed for the patient; and (4) a support network for the caregivers. Theme 4 included two sub-themes: (a) respite and emotional support and (b) occupational support. CONCLUSIONS Transitions in care present challenges for informal caregivers of older adults with frailty, who play an important role in successful transitions. Future postoperative transitional care programs should consider making targeted information, accessible communication, and support networks available for caregivers as part of facilitating successful transitions in care.
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Affiliation(s)
- Emily Hladkowicz
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus Room B311, 1053 Carling Ave, Mail Stop 249, K1Y 4E9, Ottawa, ON, Canada.
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Gurlavine Kidd
- Patient Partner, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus Room B311, 1053 Carling Ave, Mail Stop 249, K1Y 4E9, Ottawa, ON, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Wood MD, West NC, Fokkens C, Chen Y, Loftsgard KC, Cardinal K, Whyte SD, Portales-Casamar E, Görges M. An Individualized Postoperative Pain Risk Communication Tool for Use in Pediatric Surgery: Co-Design and Usability Evaluation. JMIR Pediatr Parent 2023; 6:e46785. [PMID: 37976087 PMCID: PMC10692877 DOI: 10.2196/46785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Risk identification and communication tools have the potential to improve health care by supporting clinician-patient or family discussion of treatment risks and benefits and helping patients make more informed decisions; however, they have yet to be tailored to pediatric surgery. User-centered design principles can help to ensure the successful development and uptake of health care tools. OBJECTIVE We aimed to develop and evaluate the usability of an easy-to-use tool to communicate a child's risk of postoperative pain to improve informed and collaborative preoperative decision-making between clinicians and families. METHODS With research ethics board approval, we conducted web-based co-design sessions with clinicians and family participants (people with lived surgical experience and parents of children who had recently undergone a surgical or medical procedure) at a tertiary pediatric hospital. Qualitative data from these sessions were analyzed thematically using NVivo (Lumivero) to identify design requirements to inform the iterative redesign of an existing prototype. We then evaluated the usability of our final prototype in one-to-one sessions with a new group of participants, in which we measured mental workload with the National Aeronautics and Space Administration (NASA) Task Load Index (TLX) and user satisfaction with the Post-Study System Usability Questionnaire (PSSUQ). RESULTS A total of 12 participants (8 clinicians and 4 family participants) attended 5 co-design sessions. The 5 requirements were identified: (A) present risk severity descriptively and visually; (B) ensure appearance and navigation are user-friendly; (C) frame risk identification and mitigation strategies in positive terms; (D) categorize and describe risks clearly; and (E) emphasize collaboration and effective communication. A total of 12 new participants (7 clinicians and 5 family participants) completed a usability evaluation. Tasks were completed quickly (range 5-17 s) and accurately (range 11/12, 92% to 12/12, 100%), needing only 2 requests for assistance. The median (IQR) NASA TLX performance score of 78 (66-89) indicated that participants felt able to perform the required tasks, and an overall PSSUQ score of 2.1 (IQR 1.5-2.7) suggested acceptable user satisfaction with the tool. CONCLUSIONS The key design requirements were identified, and that guided the prototype redesign, which was positively evaluated during usability testing. Implementing a personalized risk communication tool into pediatric surgery can enhance the care process and improve informed and collaborative presurgical preparation and decision-making between clinicians and families of pediatric patients.
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Affiliation(s)
- Michael D Wood
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas C West
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Christina Fokkens
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- School of Information, The University of British Columbia, Vancouver, BC, Canada
| | - Ying Chen
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- School of Information, The University of British Columbia, Vancouver, BC, Canada
| | | | - Krystal Cardinal
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Simon D Whyte
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Elodie Portales-Casamar
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- Centre de recherche, Centre Hospitalier universitaire Sainte-Justine, Montreal, QC, Canada
| | - Matthias Görges
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
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Yang MMH, Riva-Cambrin J, Cunningham J, Casha S. Validation of the Calgary Postoperative Pain after Spine Surgery Score for Poor Postoperative Pain Control after Spine Surgery. Can J Neurol Sci 2023; 50:687-693. [PMID: 36278829 DOI: 10.1017/cjn.2022.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Calgary Postoperative Pain after Spine Surgery (CAPPS) score was developed to identify patients at risk of experiencing poorly controlled pain after spine surgery. The goal of this study was to independently validate the CAPPS score on a prospectively collected patient sample. METHODS Poor postoperative pain control was defined as a mean numeric rating scale (NRS) for pain >4 at rest in the first 24 hours after surgery. Baseline characteristics in this study (validation cohort) were compared to those of the development cohort used to create the CAPPS score. Predictive performance of the CAPPS score was assessed by the area under the curve (AUC) and percentage misclassification for discrimination. A graphical comparison between predicted probability vs. observed incidence of poorly controlled pain was performed for calibration. RESULTS Fifty-two percent of 201 patients experienced poorly controlled pain. The validation cohort exhibited lower depression scores and a higher proportion using daily opioid medications compared to the development cohort. The AUC was 0.74 [95%CI = 0.68-0.81] in the validation cohort compared to 0.73 [95%CI = 0.69-0.76] in the development cohort for the eight-tier CAPPS score. When stratified between the low- vs. extreme-risk and low- vs. high-risk groups, the percentage misclassification was 21.2% and 30.7% in the validation cohort, compared to 29.9% and 38.0% in the development cohort, respectively. The predicted probability closely mirrored the observed incidence of poor pain control across all scores. CONCLUSIONS The CAPPS score, based on seven easily obtained and reliable prognostic variables, was validated using a prospectively collected, independent sample of patients.
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Affiliation(s)
- Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jonathan Cunningham
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Steven Casha
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Kokkinakis S, Kritsotakis EI, Paterakis K, Karali GA, Malikides V, Kyprianou A, Papalexandraki M, Anastasiadis CS, Zoras O, Drakos N, Kehagias I, Kehagias D, Gouvas N, Kokkinos G, Pozotou I, Papatheodorou P, Frantzeskou K, Schizas D, Syllaios A, Palios IM, Nastos K, Perdikaris M, Michalopoulos NV, Margaris I, Lolis E, Dimopoulou G, Panagiotou D, Nikolaou V, Glantzounis GK, Pappas-Gogos G, Tepelenis K, Zacharioudakis G, Tsaramanidis S, Patsarikas I, Stylianidis G, Giannos G, Karanikas M, Kofina K, Markou M, Chrysos E, Lasithiotakis K. Prospective multicenter external validation of postoperative mortality prediction tools in patients undergoing emergency laparotomy. J Trauma Acute Care Surg 2023; 94:847-856. [PMID: 36726191 DOI: 10.1097/ta.0000000000003904] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accurate preoperative risk assessment in emergency laparotomy (EL) is valuable for informed decision making and rational use of resources. Available risk prediction tools have not been validated adequately across diverse health care settings. Herein, we report a comparative external validation of four widely cited prognostic models. METHODS A multicenter cohort was prospectively composed of consecutive patients undergoing EL in 11 Greek hospitals from January 2020 to May 2021 using the National Emergency Laparotomy Audit (NELA) inclusion criteria. Thirty-day mortality risk predictions were calculated using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), NELA, Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM), and Predictive Optimal Trees in Emergency Surgery Risk tools. Surgeons' assessment of postoperative mortality using predefined cutoffs was recorded, and a surgeon-adjusted ACS-NSQIP prediction was calculated when the original model's prediction was relatively low. Predictive performances were compared using scaled Brier scores, discrimination and calibration measures and plots, and decision curve analysis. Heterogeneity across hospitals was assessed by random-effects meta-analysis. RESULTS A total of 631 patients were included, and 30-day mortality was 16.3%. The ACS-NSQIP and its surgeon-adjusted version had the highest scaled Brier scores. All models presented high discriminative ability, with concordance statistics ranging from 0.79 for P-POSSUM to 0.85 for NELA. However, except the surgeon-adjusted ACS-NSQIP (Hosmer-Lemeshow test, p = 0.742), all other models were poorly calibrated ( p < 0.001). Decision curve analysis revealed superior clinical utility of the ACS-NSQIP. Following recalibrations, predictive accuracy improved for all models, but ACS-NSQIP retained the lead. Between-hospital heterogeneity was minimum for the ACS-NSQIP model and maximum for P-POSSUM. CONCLUSION The ACS-NSQIP tool was most accurate for mortality predictions after EL in a broad external validation cohort, demonstrating utility for facilitating preoperative risk management in the Greek health care system. Subjective surgeon assessments of patient prognosis may optimize ACS-NSQIP predictions. LEVEL OF EVIDENCE Diagnostic Test/Criteria; Level II.
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Affiliation(s)
- Stamatios Kokkinakis
- From the Department of General Surgery (S.K., K.P., G.-A.K., V.M., A.K., M.P., E.C., K.L.), University Hospital of Heraklion, University of Crete, School of Medicine; Laboratory of Biostatistics, University of Crete, School of Medicine (E.I.K.); Department of Surgical Oncology, University Hospital of Heraklion, University of Crete, School of Medicine (C.S.A., O.Z.), Heraklion; Department of Surgery, University General Hospital of Patras, School of Medicine (N.D., I.K., D.K.), University of Patras, Patras, Greece; Department of Surgery, General Hospital of Nicosia, School of Medicine (N.G., G.K., I.P., P.P., K.F.), University of Cyprus, Nicosia, Cyprus; First Department of Surgery (D.S., A.S.) and Second Propaedeutic Department of Surgery (I.M.P.), Laikon General Hospital, National and Kapodistrian University of Athens; Department of Surgery, University General Hospital Attikon, School of Medicine (K.N., M.P., N.V.M., I.M.), University of Athens, Athens; Department of Surgery (E.L., G.D.), General Hospital of Volos, Volos, Greece; Department of Surgery (D.P., V.N.), General Hospital of Trikala, Trikala; Department of Surgery (G.K.G., G.P.-G., K.T.), University Hospital of Ioannina, Ioannina, Greece; Department of Surgery, Ippokrateion General Hospital of Thessaloniki, School of Medicine (G.Z., S.T., I.P.), Aristotle University of Thessaloniki, Thessaloniki; Second Department of Surgery (G.S., G.G.), Evangelismos General Hospital, Athens; and Department of Surgery, University General Hospital of Alexandroupolis, School of Medicine (M.K., K.K., M.M.), University of Thrace, Alexandroupolis, Greece
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Graeßner M, Jungwirth B, Frank E, Schaller SJ, Kochs E, Ulm K, Blobner M, Ulm B, Podtschaske AH, Kagerbauer SM. Enabling personalized perioperative risk prediction by using a machine-learning model based on preoperative data. Sci Rep 2023; 13:7128. [PMID: 37130884 PMCID: PMC10153050 DOI: 10.1038/s41598-023-33981-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/21/2023] [Indexed: 05/04/2023] Open
Abstract
Preoperative risk assessment is essential for shared decision-making and adequate perioperative care. Common scores provide limited predictive quality and lack personalized information. The aim of this study was to create an interpretable machine-learning-based model to assess the patient's individual risk of postoperative mortality based on preoperative data to allow analysis of personal risk factors. After ethical approval, a model for prediction of postoperative in-hospital mortality based on preoperative data of 66,846 patients undergoing elective non-cardiac surgery between June 2014 and March 2020 was created with extreme gradient boosting. Model performance and the most relevant parameters were shown using receiver operating characteristic (ROC-) and precision-recall (PR-) curves and importance plots. Individual risks of index patients were presented in waterfall diagrams. The model included 201 features and showed good predictive abilities with an area under receiver operating characteristic (AUROC) curve of 0.95 and an area under precision-recall curve (AUPRC) of 0.109. The feature with the highest information gain was the preoperative order for red packed cell concentrates followed by age and c-reactive protein. Individual risk factors could be identified on patient level. We created a highly accurate and interpretable machine learning model to preoperatively predict the risk of postoperative in-hospital mortality. The algorithm can be used to identify factors susceptible to preoperative optimization measures and to identify risk factors influencing individual patient risk.
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Affiliation(s)
- Martin Graeßner
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Elke Frank
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- Commercial department, Klinikum rechts der isar, Technical University of Munich, Munich, Germany
| | - Stefan Josef Schaller
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eberhard Kochs
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kurt Ulm
- Department of Medical Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Manfred Blobner
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Bernhard Ulm
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Armin Horst Podtschaske
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Simone Maria Kagerbauer
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany.
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Lee A, Moonesinghe SR. When (not) to apply clinical risk prediction models to improve patient care. Anaesthesia 2023; 78:547-550. [PMID: 36860118 DOI: 10.1111/anae.15990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Affiliation(s)
- A Lee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - S R Moonesinghe
- Research Department for Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
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Combining reconstructive and ablative surgical treatment of chronic breast cancer-related lymphedema (BCRL): safe and effective. Breast Cancer Res Treat 2023; 197:83-92. [PMID: 36287309 PMCID: PMC9823021 DOI: 10.1007/s10549-022-06778-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE We investigated whether a one-stage combination of vascularized lymph node transfer (VLNT) with water jet-assisted liposuction (WAL) can be safely performed and results in improved patient outcomes such as a greater reduction in arm volume when treating chronic breast cancer-related lymphedema (BCRL). METHODS In this retrospective cohort study, we included all patients from our encrypted lymphedema database treated for chronic BCRL with VLNT or VLNT + WAL who had a minimum follow-up of two years. We analyzed patient-specific variables including arm circumferences as well as patient-reported outcomes before and after surgery as well as surgery time, surgery-related complications and patient satisfaction. RESULTS Only the mean preoperative differences of the circumferences between the lymphedematous and the unaffected arm in individual patients showed a statistically significant difference between treatment groups (p < 0.05). Indeed, patients treated with VLNT + WAL had consistently larger differences in individual sets of arms and therefore more pronounced chronic BCRL. The mean surgery time was significantly longer in the VLNT + WAL group (p < 0.05). Complications were seldom and similar in both groups. Using a numeric rating scale, the level of patient satisfaction following treatment did not differ significantly between groups (p = 0.323). CONCLUSIONS Our findings suggest that a one-stage combination of VLNT with WAL does not result in more complications even though it also entails a longer surgery time. This is acceptable as secondary interventions resulting in overall longer surgery times and higher costs can be avoided. A one-stage combination might be especially favourable for patients suffering from more severe chronic BCRL.
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Vromans RD, Hommes S, Clouth FJ, Lo-Fo-Wong DNN, Verbeek XAAM, van de Poll-Franse L, Pauws S, Krahmer E. Need for numbers: assessing cancer survivors' needs for personalized and generic statistical information. BMC Med Inform Decis Mak 2022; 22:260. [PMID: 36199092 PMCID: PMC9535944 DOI: 10.1186/s12911-022-02005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Statistical information (e.g., on long-term survival or side effects) may be valuable for healthcare providers to share with their patients to facilitate shared decision making on treatment options. In this pre-registered study, we assessed cancer survivors’ need for generic (population-based) versus personalized (tailored towards patient/tumor characteristics) statistical information after their diagnosis. We examined how information coping style, subjective numeracy, and anxiety levels of survivors relate to these needs and identified statistical need profiles. Additionally, we qualitatively explored survivors’ considerations for (not) wanting statistical information. Methods Cancer survivors’ need for statistics regarding incidence, survival, recurrence, side effects and quality of life were assessed with an online questionnaire. For each of these topics, survivors were asked to think back to their first cancer diagnosis and to indicate their need for generic and personalized statistics on a 4-point scale (‘not at all’- ‘very much’). Associations between information coping style, subjective numeracy, and anxiety with need for generic and personalized statistics were examined with Pearson’s correlations. Statistical need profiles were identified using latent class analysis. Considerations for (not) wanting statistics were analyzed qualitatively. Results Overall, cancer survivors (n = 174) had a higher need for personalized than for generic statistics (p < .001, d = 0.74). Need for personalized statistics was associated with higher subjective numeracy (r = .29) and an information-seeking coping style (r = .41). Three statistical need profiles were identified (1) a strong need for both generic and personalized statistics (34%), (2) a stronger need for personalized than for generic statistics (55%), and (3) a little need for both generic and personalized statistics (11%). Considerations for wanting personalized cancer statistics ranged from feelings of being in control to making better informed decisions about treatment. Considerations for not wanting statistics related to negative experience with statistics and to the unpredictability of future events for individual patients. Conclusions In light of the increased possibilities for using personalized statistics in clinical practice and decision aids, it appears that most cancer survivors want personalized statistical information during treatment decision-making. Subjective numeracy and information coping style seem important factors influencing this need. We encourage further development and implementation of data-driven personalized decision support technologies in oncological care to support patients in treatment decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-02005-2.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands. .,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | - Saar Hommes
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Felix J Clouth
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Statistics and Methodology, Tilburg School of Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Deborah N N Lo-Fo-Wong
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xander A A M Verbeek
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg School of Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands.,Collaborative Care Solutions, Philips Research, Eindhoven, The Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands
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Wood MD, Correa K, Ding P, Sreepada R, Loftsgard KC, Jordan I, West NC, Whyte SD, Portales-Casamar E, Görges M. Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members. JMIR Pediatr Parent 2022; 5:e37353. [PMID: 35838823 PMCID: PMC9338417 DOI: 10.2196/37353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pediatric surgery is associated with a risk of postoperative pain that can impact the family's quality of life. Although some risk factors for postoperative pain are known, these are often not consistently communicated to families. In addition, although tools for risk communication exist in other domains, none are tailored to pediatric surgery. OBJECTIVE As part of a larger project to develop pain risk prediction tools, we aimed to design an easy-to-use tool to effectively communicate a child's risk of postoperative pain to both clinicians and family members. METHODS With research ethics board approval, we conducted virtual focus groups (~1 hour each) comprising clinicians and family members (people with lived surgical experience and parents of children who had recently undergone surgery/medical procedures) at a tertiary pediatric hospital to understand and evaluate potential design approaches and strategies for effectively communicating and visualizing postoperative pain risk. Data were analyzed thematically to generate design requirements and to inform iterative prototype development. RESULTS In total, 19 participants (clinicians: n=10, 53%; family members: n=9, 47%) attended 6 focus group sessions. Participants indicated that risk was typically communicated verbally by clinicians to patients and their families, with severity indicated using a descriptive or a numerical representation or both, which would only occasionally be contextualized. Participants indicated that risk communication tools were seldom used but that families would benefit from risk information, time to reflect on the information, and follow-up with questions. In addition, 9 key design requirements and feature considerations for effective risk communication were identified: (1) present risk information clearly and with contextualization, (2) quantify the risk and contextualize it, (3) include checklists for preoperative family preparation, (4) provide risk information digitally to facilitate recall and sharing, (5) query the family's understanding to ensure comprehension of risk, (6) present the risk score using multimodal formats, (7) use color coding that is nonthreatening and avoids limitations with color blindness, (8) present the most significant factors contributing to the risk prediction, and (9) provide risk mitigation strategies to potentially decrease the patient's level of risk. CONCLUSIONS Key design requirements for a pediatric postoperative pain risk visualization tool were established and guided the development of an initial prototype. Implementing a risk communication tool into clinical practice has the potential to bridge existing gaps in the accessibility, utilization, and comprehension of personalized risk information between health care professionals and family members. Future iterative codesign and clinical evaluation of this risk communication tool are needed to confirm its utility in practice.
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Affiliation(s)
- Michael D Wood
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Kim Correa
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,School of Information, The University of British Columbia, Vancouver, BC, Canada
| | - Peijia Ding
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rama Sreepada
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Nicholas C West
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Simon D Whyte
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Elodie Portales-Casamar
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Matthias Görges
- Department of Anesthesiology Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Petrescu M, Popa F, Purcărea VL. How could perioperative anxiety be addressed via surgical team communication approaches? Findings from a scoping review. Hosp Pract (1995) 2022; 50:159-169. [PMID: 35345958 DOI: 10.1080/21548331.2022.2059979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Surgical patients and their families experience high rates of perioperative anxiety, which determine a negative impact on their surgery-related outcomes. Understanding what communicational aspects positively impact perioperative anxiety may help promote more efficient, patient-centered communication approaches which could address this issue. The aim of this scoping review was to synthesize published research on communication between surgical employees and adult patients and their relatives, and its role in managing perioperative anxiety. METHODS A scoping review approach was used across four international databases to search for publications detailing communicational interventions and approaches employed in surgical contexts and their impact on surgical patients' and their caregivers' perioperative anxiety levels. Results were narratively synthesized. RESULTS Twenty-two studies were included in this scoping review, which were grouped according to their communication intervention into one of five categories: technology-assisted interventions, interpersonal communication, educational programs, tools for facilitating exchange of information and theory-derived communication strategies. Records reported mixed results in terms of reducing perioperative anxiety. Facilitating and hindering factors in interpersonal communication in this context were further synthesized. CONCLUSION A multitude of communicational approaches and their effect on anxiety have been investigated within surgical settings, with varying results. Existing evidence suggests that it is vital to address surgical patients' anxiety through personalized empathetic communication, tailored to an individual's case, preferences, and needs. Key aspects of patient-healthcare professional communication which may impact perioperative anxiety were identified and may be utilized in future trainings for communication skills among surgical teams.
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Affiliation(s)
- Mariana Petrescu
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Florian Popa
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
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Dabbagh A, Gandomkar R, Farzanegan B, Jaffari A, Massoudi N, Mirkheshti A, Moshari M, Nashibi M, Razavi SS, Sezari P, Tabashi S, Tajbakhsh A, Vosoughian M. Residency Education Reform Program in Department of Anesthesiology and Critical Care: An Academic Reform Model. Anesth Pain Med 2021; 11:e113606. [PMID: 34540632 PMCID: PMC8438708 DOI: 10.5812/aapm.113606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/05/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Reform in medical education is a basic process in every academic department, especially in residency programs. Objectives This study was designed to assess the indices of education and research as part of the Medical Education Reform program (MERP) in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU) for four years. Methods MERP in DACC, SBMU was designed and implemented as a modern academic reform model; different outcome measures in education and research were assessed to demonstrate the effects of the reform plan in academic improvements. Results there were significant improvements regarding education indices (i.e., teaching methods, passing comprehensive exams, mentorship, assessment methods, faculty development, professionalism in medical education, integration in education, and crisis management) and research indices (targeted research activities, innovation in research approaches, increasing the impact of research). Conclusions Based on the experiences of DACC, SBMU regarding clinical anesthesiology residency, reform could be achieved using painstaking plans and continuous efforts with tangible documented outcomes. Often, the management period is not durable, and these reforms require meticulous care to sustain.
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Affiliation(s)
- Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Roghayeh Gandomkar
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Farzanegan
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jaffari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nilofar Massoudi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mirkheshti
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Moshari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Nashibi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Sajad Razavi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parissa Sezari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Tabashi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ardeshir Tajbakhsh
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vosoughian
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chudgar NP, Yan S, Hsu M, Tan KS, Gray KD, Nobel T, Molena D, Sihag S, Bott M, Jones DR, Rusch VW, Rocco G, Isbell JM. External Validation of Surgical Risk Preoperative Assessment System in Pulmonary Resection. Ann Thorac Surg 2020; 112:228-237. [PMID: 33075325 DOI: 10.1016/j.athoracsur.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate preoperative risk assessment is necessary for informed decision making for patients and surgeons. Several preoperative risk calculators are available but few have been examined in the general thoracic surgical patient population. The Surgical Risk Preoperative Assessment System (SURPAS), a risk-assessment tool applicable to a wide spectrum of surgical procedures, was developed to predict the risks of common adverse postoperative outcomes using a parsimonious set of preoperative input variables. We sought to externally validate the performance of SURPAS for postoperative complications in patients undergoing pulmonary resection. METHODS Between January 2016 and December 2018, 2514 patients underwent pulmonary resection at our center. Using data from our institution's prospectively maintained database, we calculated the predicted risks of 12 categories of postoperative outcomes using the latest version of SURPAS. Performance of SURPAS against observed patient outcomes was assessed by discrimination (concordance index) and calibration (calibration curves). RESULTS The discrimination ability of SURPAS was moderate across all outcomes (concordance indices, 0.640 to 0.788). Calibration curves indicated good calibration for all outcomes except infectious and cardiac complications, discharge to a location other than home, and mortality (all overestimated by SURPAS). CONCLUSIONS SURPAS demonstrates outcomes for pulmonary resections with reasonable predictive ability. Discretion should be applied when assessing risk for postoperative infectious and cardiac complications, discharge to a location other than home, and mortality. Although the parsimonious nature of SURPAS is one of its strengths, its performance might be improved by including additional factors known to influence outcomes after pulmonary resection, such as sex and pulmonary function.
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Affiliation(s)
- Neel P Chudgar
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shi Yan
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Meier Hsu
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine D Gray
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Tamar Nobel
- Department of Surgery, Mount Sinai Hospital, New York, New York
| | - Daniela Molena
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Smita Sihag
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Bott
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gaetano Rocco
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M Isbell
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Hladkowicz E, Yachnin D, Boland L, Wilson K, McKinnon A, Hawrysh K, Hawrysh T, Bell C, Atkinson K, van Walraven C, Taljaard M, Thavorn K, Stacey D, Yang H, Pysyk C, Moloo H, Manuel D, MacDonald D, Lavallée LT, Gagne S, Forster AJ, Bryson GL, McIsaac DI. Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study. Can J Anaesth 2020; 67:1749-1760. [PMID: 32929659 DOI: 10.1007/s12630-020-01809-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk communication tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care. METHODS We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application's materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability. RESULTS We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (- 1.9%; 95% CI, - 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists. CONCLUSION Exposure to a patient-facing, personalized risk communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.
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Affiliation(s)
- Emily Hladkowicz
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,School of Rehabilitation Therapy, Queens' University, Kingston, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Yachnin
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laura Boland
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Health Studies, Western University, London, ON, Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | | | - Cameron Bell
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Katherine Atkinson
- Department of Public Health Science, Karolinska Institute, Solna, Sweden
| | - Carl van Walraven
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Homer Yang
- Department of Anesthesia and Perioperative Medicine, Western University, London, ON, Canada
| | - Christopher Pysyk
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Husein Moloo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Doug Manuel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David MacDonald
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Sylvain Gagne
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan J Forster
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gregory L Bryson
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. .,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
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Abstract
Background
A barrier to routine preoperative frailty assessment is the large number of frailty instruments described. Previous systematic reviews estimate the association of frailty with outcomes, but none have evaluated outcomes at the individual instrument level or specific to clinical assessment of frailty, which must combine accuracy with feasibility to support clinical practice.
Methods
The authors conducted a preregistered systematic review (CRD42019107551) of studies prospectively applying a frailty instrument in a clinical setting before surgery. Medline, Excerpta Medica Database, Cochrane Library and the Comprehensive Index to Nursing and Allied Health Literature, and Cochrane databases were searched using a peer-reviewed strategy. All stages of the review were completed in duplicate. The primary outcome was mortality and secondary outcomes reflected routinely collected and patient-centered measures; feasibility measures were also collected. Effect estimates were pooled using random-effects models or narratively synthesized. Risk of bias was assessed.
Results
Seventy studies were included; 45 contributed to meta-analyses. Frailty was defined using 35 different instruments; five were meta-analyzed, with the Fried Phenotype having the largest number of studies. Most strongly associated with: mortality and nonfavorable discharge was the Clinical Frailty Scale (odds ratio, 4.89; 95% CI, 1.83 to 13.05 and odds ratio, 6.31; 95% CI, 4.00 to 9.94, respectively); complications was associated with the Edmonton Frail Scale (odds ratio, 2.93; 95% CI, 1.52 to 5.65); and delirium was associated with the Frailty Phenotype (odds ratio, 3.79; 95% CI, 1.75 to 8.22). The Clinical Frailty Scale had the highest reported measures of feasibility.
Conclusions
Clinicians should consider accuracy and feasibility when choosing a frailty instrument. Strong evidence in both domains support the Clinical Frailty Scale, while the Fried Phenotype may require a trade-off of accuracy with lower feasibility.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Perioperative outcomes: easier to predict but harder to change. Can J Anaesth 2019; 66:1014-1017. [DOI: 10.1007/s12630-019-01434-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 05/10/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022] Open
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