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Osório F, Hipólito-Reis H, Almeida P, Mourão J, Fougo JL. Same-day discharge pathway for breast cancer surgery in patients aged over 80: A feasibility study. J Geriatr Oncol 2023:101518. [PMID: 37230930 DOI: 10.1016/j.jgo.2023.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/21/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Fernando Osório
- Breast Center, S. João University Hospital, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; pGA>70 Program, São João University Hospital, Porto, Portugal; CINTESIS@RISE, GeriMHealth, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Helena Hipólito-Reis
- pGA>70 Program, São João University Hospital, Porto, Portugal; Department of Internal Medicine, São João University Hospital, Porto, Portugal
| | - Paulo Almeida
- pGA>70 Program, São João University Hospital, Porto, Portugal; Department of Internal Medicine, São João University Hospital, Porto, Portugal
| | - Joana Mourão
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; pGA>70 Program, São João University Hospital, Porto, Portugal; Department of Anesthesiology, São João University Hospital, Porto, Portugal
| | - José Luís Fougo
- Breast Center, S. João University Hospital, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Aristokleous I, Öberg J, Pantiora E, Sjökvist O, Navia JE, Mani M, Karakatsanis A. Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: A cross-sectional study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:60-67. [PMID: 36088236 DOI: 10.1016/j.ejso.2022.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM). METHODS This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews. RESULTS There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy. CONCLUSIONS These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.
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Affiliation(s)
- Iliana Aristokleous
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Johanna Öberg
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Eirini Pantiora
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Olivia Sjökvist
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 75237, Uppsala, Sweden
| | - Jaime E Navia
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Maria Mani
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 75237, Uppsala, Sweden
| | - Andreas Karakatsanis
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden.
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Samuel AR, Fuhr L, DeGeorge BR, Black J, Campbell C, Stranix JT. Prolonged Opioid Use Among Opioid-Naive Women Undergoing Breast Reconstructive Surgery. Arch Plast Surg 2022; 49:339-345. [PMID: 35832151 PMCID: PMC9142247 DOI: 10.1055/s-0042-1744419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Abstract
Background Patients that undergo mastectomy for breast cancer with reconstruction may be prone to prolonged opioid use. As risk factors are not well-established, this article sought to better understand the risk factors that may be associated with this.
Methods Patients that underwent breast reconstruction between 2010 and 2018 were identified in PearlDiver, a national insurance claims database. Patient demographics and comorbidities were elucidated, and various complications were then identified. Descriptive statistics as well as a multivariate analysis was used to evaluate the association of risk factors and complications.
Results Breast reconstruction patients of 24,765 were identified from this database. Obesity, tobacco use, benzodiazepine use, and anticonvulsant use were all associated with prolonged opioid prescriptions greater than 90 days after both alloplastic and autologous reconstruction.
Conclusion Prolonged opioid use continues to remain a topic of concern, and particularly in cancer patients that undergo breast reconstruction. Providers should be aware of potential risk factors for this to reduce this chance following breast reconstruction surgery.
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Affiliation(s)
- Ankhita R. Samuel
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Laura Fuhr
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brent R. DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Jonathan Black
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Christopher Campbell
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - John T. Stranix
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
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Ren W, Sun L, Tarimo CS, Li Q, Wu J. The situation and influencing factors of outpatient satisfaction in large hospitals: Evidence from Henan province, China. BMC Health Serv Res 2021; 21:500. [PMID: 34034724 PMCID: PMC8145824 DOI: 10.1186/s12913-021-06520-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The level of outpatient satisfaction plays a significant role in improving the quality and utilization of healthcare services. Patient satisfaction gives providers insights into various aspects of services including the effectiveness of care and level of empathy. This study aimed to evaluate the level of patient satisfaction in the outpatient department and to explore its influencing factors in large hospitals (accommodating over 1000 beds) of Henan province, China. METHODS We analyzed data from Henan Large Hospitals Patient Satisfaction Survey conducted in the year 2018 and included 630 outpatients. Structural Equation Model (SEM) was used to explore the relationship among evaluation indicators of outpatient satisfaction levels. We used Dynamic Matter-Element Analysis (DMA) to evaluate the status of outpatient satisfaction. Binary Logistic Regression (BLR) was adopted to estimate the impact of personal characteristics towards outpatient satisfaction. RESULTS The overall score for outpatient satisfaction in large hospitals was 66.28±14.73. The mean outpatient satisfaction scores for normal-large, medium-large, and extra-large hospitals were 63.33±12.12, 70.11±16.10, 65.41±14.67, respectively, and were significantly different (F = 11.953, P < 0.001). Waiting time, doctor-patient communication, professional services, and accessibility for treatment information were shown to have directly positive correlations with outpatient satisfaction (r = 0.42, 0.47, 0.55, 0.46, all P < 0.05). Results from BLR analysis revealed that patients' age and frequency of hospital visits were the main characteristics influencing outpatient satisfaction (P < 0.05). CONCLUSIONS The outpatient satisfaction of large hospitals is moderately low. Hospital managers could shorten the waiting time for outpatients and improve the access to treatment information to improve the satisfaction of outpatients. It is also necessary to enhance service provision for outpatients under the age of 18 as well as the first-time patients.
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Affiliation(s)
- Weicun Ren
- College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
- College of Sanquan, Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Lei Sun
- College of Sanquan, Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Clifford Silver Tarimo
- College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
- Department of Science and Laboratory Technology, Dares Salaam Institute of Technology, Dares Salaam, Tanzania
| | - Quanman Li
- College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jian Wu
- College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China.
- College of Sanquan, Xinxiang Medical University, Xinxiang, People's Republic of China.
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Saldivar B, Carter C, Filipp SL, Gurka MJ, Davis MK. Patient Satisfaction Surveys in the Outpatient Clinic Setting: The Variability of Response With Positively or Negatively Toned Questions. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019875554. [PMID: 31524021 PMCID: PMC6747859 DOI: 10.1177/0046958019875554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to determine whether a patient satisfaction survey in the outpatient clinic setting using questions with either a positive or negative tone would produce consistent responses. This was a prospective study using a 20-question paper survey delivered to medical students who were asked to rate on a scale of 1 to 10 to what degree they either agree or disagree with statements regarding their most recent personal outpatient clinic health care visit (any medical specialty). The same survey was administered again through an e-mail link 1 week later. One hundred fifty (77%) students completed the 20-item survey and 53 (35%) of the participating students completed the follow-up e-mail survey. Seven of the 10 question pairs on the paper survey revealed statistically significant differences in responses based on tone, with greater values for disagreement with negatively toned questions than values representing agreement with positive-toned questions. The match rates for similar questions posed on the paper survey and then the e-mail survey 1 week later ranged between 27.8% and 56.6%. This study demonstrated that, with an outpatient health care patient satisfaction survey, disagreement with a negative-toned question was stronger than agreement with a positive-toned question. There was poor correlation between survey responses when first posed on a paper survey and then repeated on a digital survey 1 week later. These findings suggest that the wording of survey questions may affect responses and that survey answers change with time and across delivery platforms.
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Affiliation(s)
| | | | | | | | - Michael K. Davis
- University of Florida, Gainesville, USA
- Michael K. Davis, Assistant Clinical Professor, Division of General Pediatrics, University of Florida Health, 7046 SW Archer Road, Gainesville, FL 32611-7011, USA.
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