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Jules-Elysee KM, Sigmund AE, Tsai MH, Simmons JW. Expanding the perioperative lens: Does the end justify the means? J Clin Anesth 2024; 97:111522. [PMID: 38870702 DOI: 10.1016/j.jclinane.2024.111522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/26/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
In 1994, Fischer et al. established the preoperative clinic for the perioperative services at Stanford University Medical Center. By lowering the risk of cancellation and reducing morbidity and mortality against the push to move surgeries to an outpatient, basis, they demonstrated a return on investment. In the 2000s, Aronson et al. designed the prehabilitation clinics at Duke University with the notion that the preoperative process should not only ensure that patients were appropriately risk-stratified, but also clinically optimized before surgery. With a trend towards ambulatory procedures due to current reimbursement structures, hospital administrators should be searching for potential avenues to bolster sagging profits. In this narrative review, we argue that the perioperative services needs to extend beyond the hospital into the postoperative period.
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Affiliation(s)
- Kethy M Jules-Elysee
- Hospital for Special Surgery, Department of Anesthesiology, Critical Care, and Pain Management, New York, NY, USA.
| | - Alana E Sigmund
- Hospital for Special Surgery, Department of Internal Medicine, Division of Perioperative Medicine, New York, NY, USA.
| | - Mitchell H Tsai
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA; Department of Anesthesiology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA; Department of Anesthesiology, University of Vermont, Larner College of Medicine, Burlington, VT, USA; Department of Orthopedics and Rehabilitation (by courtesy), Department of Surgery (by courtesy), Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | - Jeff W Simmons
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA.
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Milam AJ, Bonner T, Burton BN, Williams B, Youssef MR, Smith RN, Cannesson M, Troianos C, Pittet JF. The Difficulty Implementing Evidence-Based Practice in the Perioperative Setting. Anesth Analg 2024; 139:874-880. [PMID: 39052524 DOI: 10.1213/ane.0000000000006916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Adam J Milam
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Timethia Bonner
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Brittney Williams
- Department of Anesthesiology, University of Maryland, Baltimore, Baltimore, Maryland
| | - Mohanad R Youssef
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | | | - Jean-Francois Pittet
- Deparment of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Wahl Z, Courbon C, Macindo JRB, Torres GCS, Lecoultre C. Surgical Patient Preoperative Readiness: Translation into French, Cultural Adaptation for Switzerland and Cross-Sectional Exploratory Study in a Tertiary Hospital. J Perianesth Nurs 2024:S1089-9472(24)00051-0. [PMID: 38819361 DOI: 10.1016/j.jopan.2024.02.005] [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: 10/18/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Preoperative evaluation of elective surgery patients traditionally focuses on somatic and organizational aspects of the situation. Patient feelings of readiness, called preoperative readiness (PR), impacts postoperative outcomes, and yet is rarely evaluated. The Preoperative Assessment Tool (PART) is a validated and reliable 15-item questionnaire available in Filipino and English. A reliable tool is essential for evaluating PR within the Swiss health context to offer optimized and comprehensive perioperative care. The aim of this study was to both translate into French and adapt culturally the Preoperative Assessment Tool for Switzerland's francophone population, and to explore patient PR in the preoperative consultation within a Swiss tertiary hospital. DESIGN A mixed design with methodologic phases and descriptive study. METHODS A mixed design in two phases with a methodologic phase with (1) translation and (2) cultural adaptation for Romandie of the PART, following Wild's 10 steps methodology (n = 11) and (3) a cross-sectional exploratory descriptive study with pilot testing of the translated version in a general elective preoperative consultation in a tertiary hospital in Romandie (N = 88). FINDINGS Translation and cultural adaptations are well accepted and understood by the participants (n = 9/11), modifications are accepted by the authors and deemed adequate by the participants (n = 11/11). Time of completion is short (m = 69.06 seconds) and adapted to clinical context. The translated version has a Cronbach (α = 0.85) comparable to the original validated scale (α = 0.86). CONCLUSIONS The translation and cultural adaptation for Switzerland of the PART was achieved, and PR was explored. Further psychometric testing of the PART-FrenCH must be conducted to assess fully the tool before its use in a clinical setting. Including PR in preoperative evaluations could enhance patient-centered approaches and lead to improvement in the quality of care.
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Affiliation(s)
- Zoé Wahl
- Department of Nursing, Haute Ecole de Santé Vaud (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Vaud, Switzerland; College of Nursing, Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Vaud, Switzerland.
| | - Cécile Courbon
- Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland
| | | | - Gian Carlo S Torres
- College of Nursing, University of Santo Tomas, Manila, Philippines; College of Nursing, University of the Philippines, Manila, Philippines
| | - Claudia Lecoultre
- Department of Surgery and Cardio-Vascular, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland
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Chen W, Zheng Z, Liu Y. Evaluating the potential of GPT-4 in assisting communication in clinical anaesthesia: A quantitative assessment. Eur J Anaesthesiol 2024; 41:321-323. [PMID: 38293731 DOI: 10.1097/eja.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Wanpei Chen
- From the Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (WC, YL) and Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (ZZ)
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Shawahna R, Jaber M, Maqboul I, Hijaz H, Arjan E, Karaki M, Nasser K. Fear of anesthesia for cesarean section among pregnant women: a multicenter cross-sectional study. Perioper Med (Lond) 2023; 12:63. [PMID: 38001519 PMCID: PMC10675949 DOI: 10.1186/s13741-023-00353-9] [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: 06/30/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Fear of anesthesia for cesarean section delivery is an important health issue that should be addressed by anesthesiologists, obstetricians, and other providers of antenatal and perioperative healthcare. This multicenter study was conducted to assess the fear of anesthesia for cesarean section among Palestinian pregnant women and to identify the predictors of high fear. METHODS The study was conducted in a cross-sectional design among Palestinian pregnant women in different antenatal healthcare clinics. The study participants were recruited using a convenience sampling procedure. The pregnant women were asked to respond to items in a questionnaire. RESULTS In this study, a total of 394 pregnant women completed the questionnaires. Of the pregnant women, 280 (71.1%) have had cesarean delivery under anesthesia, and 104 (26.4%) elected cesarean delivery. Multiple linear regression showed that higher fear scores were predicted by having a university degree (p-value < 0.001), living in rural areas (p-value = 0.007), dissatisfaction with social life (p-value = 0.004), satisfaction with religious commitment (p-value = 0.001), having had cesarean delivery under anesthesia (p-value = 0.005), and preference of cesarean delivery (p-value < 0.001). CONCLUSION Fear of anesthesia was prevalent among pregnant women in Palestine. Higher fear could be predicted by education level, place of residence, satisfaction with social life, satisfaction with religious commitment, having had cesarean delivery under anesthesia, and preference for normal delivery. Anesthesiologists, gynecologists and obstetricians, nurses, midwives, and other providers of antenatal and perioperative healthcare services should consider these factors while counseling pregnant women and addressing their fear of anesthesia.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- An-Najah National University Hospital, An-Najah National University, Nablus, Palestine.
| | - Iyad Maqboul
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Hatim Hijaz
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- An-Najah National University Hospital, An-Najah National University, Nablus, Palestine.
| | - Eman Arjan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Maisa Karaki
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Keen Nasser
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Scheel-Sailer A, Eich S, Jelmoni L, Lampart P, Schwitter M, Sigrist-Nix D, Langewitz W. Effect of an interprofessional small-group communication skills training incorporating critical incident approaches in an acute care and rehabilitation clinic specialized for spinal cord injury and disorder. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:883138. [PMID: 36188965 PMCID: PMC9397787 DOI: 10.3389/fresc.2022.883138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
Aim To investigate the impact of site-specific inter-professional small-group communication skills training (CST) that incorporates critical incident approaches to learning on patient satisfaction with communication. Setting Rehabilitation clinic specialized for spinal cord injury/disorder (SCI/D). Methods Retrospective observational cohort study design using patient and health-professional self-report data. Data for patient satisfaction with communication were collected in 2014 (existing records) and each year from 2015 to 2021 (post-program; volunteers) using the MECON survey. Results Fifteen basic (n = 161 participants), 16 refresher (n = 84), and five short (n = 17) CST seminars were conducted. Overall, 262 employees (105 physicians, 63 nurses, 36 physio- and occupational therapists, and 58 others) participated; 92 participants (response rate 37.6%) responded to feedback surveys. They rated the seminars positive concerning the alternation between theory, discussion, and practical exercise in 91.3%, and rated the length of the training ideal in 80.2%. Post-program patient satisfaction overall increased from 83.1% (confidence interval (CI) 2.6%) to 90% (CI 0.8%; R2 = 0.776; p= 0.004). It was higher in specific communication-related topics: "receiving information" (81.1%, CI 3.1-90.2%, CI 1.0%; p = 0.003), "being able to bring in concerns" (83%, CI 1.0-90.8%; R2 = 0.707; p = 0.009) and "being treated with respect" (89.4%, CI 2.6-94.4%, CI 0.8%; R2 = 0.708; p = 0.004). Practice implications Inter-professional CST is feasible and well accepted by professionals from various professional groups. During seven years of continuous training, independent patient ratings of satisfaction with professional communication have improved significantly. Participants attest to the training's high credibility and usefulness in everyday life.
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Affiliation(s)
- Anke Scheel-Sailer
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stephanie Eich
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Luca Jelmoni
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Patricia Lampart
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Diana Sigrist-Nix
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- MECON Measure & Consult GmbH, Zürich, Switzerland
| | - Wolf Langewitz
- Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
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Robertson AC, Fowler LC, Kimball TS, Niconchuk JA, Kreger MT, Brovman EY, Rickerson E, Sadovnikoff N, Hepner DL, McEvoy MD, Bader AM, Urman RD. Efficacy of an Online Curriculum for Perioperative Goals of Care and Code Status Discussions: A Randomized Controlled Trial. Anesth Analg 2021; 132:1738-1747. [PMID: 33886519 DOI: 10.1213/ane.0000000000005548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preoperative goals of care (GOC) and code status (CS) discussions are important in achieving an in-depth understanding of the patient's care goals in the setting of a serious illness, enabling the clinician to ensure patient autonomy and shared decision making. Past studies have shown that anesthesiologists are not formally trained in leading these discussions and may lack the necessary skill set. We created an innovative online video curriculum designed to teach these skills. This curriculum was compared to a traditional method of learning from reading the medical literature. METHODS In this bi-institutional randomized controlled trial at 2 major academic medical centers, 60 anesthesiology trainees were randomized to receive the educational content in 1 of 2 formats: (1) the novel video curriculum (video group) or (2) journal articles (reading group). Thirty residents were assigned to the experimental video curriculum group, and 30 were assigned to the reading group. The content incorporated into the 2 formats focused on general preoperative evaluation of patients and communication strategies pertaining to GOC and CS discussions. Residents in both groups underwent a pre- and postintervention objective structured clinical examination (OSCE) with standardized patients. Both OSCEs were scored using the same 24-point rubric. Score changes between the 2 OSCEs were examined using linear regression, and interrater reliability was assessed using weighted Cohen's kappa. RESULTS Residents receiving the video curriculum performed significantly better overall on the OSCE encounter, with a mean score of 4.19 compared to 3.79 in the reading group. The video curriculum group also demonstrated statistically significant increased scores on 8 of 24 rubric categories when compared to the reading group. CONCLUSIONS Our novel video curriculum led to significant increases in resident performance during simulated GOC discussions and modest increases during CS discussions. Further development and refinement of this curriculum are warranted.
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Affiliation(s)
- Amy C Robertson
- From the Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Leslie C Fowler
- From the Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Thomas S Kimball
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jonathan A Niconchuk
- From the Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael T Kreger
- Department of Anesthesiology, Southeast Health Medical Center, Dothan, Alabama
| | - Ethan Y Brovman
- Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Elizabeth Rickerson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nicholas Sadovnikoff
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew D McEvoy
- From the Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Sacca L, Maroun V, Khoury M. Predictors of high trust and the role of confidence levels in seeking cancer-related information. Inform Health Soc Care 2021; 47:53-61. [PMID: 34014145 DOI: 10.1080/17538157.2021.1925676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
One of the most commonly searched topics on the internet in the United States is cancer. Our study aims to provide a general overview of the predictors of trust for two health information sources, doctors and the internet, when seeking cancer-related information. The data were obtained from the 2018 HINTS 5 Cycle 2 survey, which was administered from January through May to a total of 3,504 respondents. We carried out next a series of ordinal logistic regression models to identify predictors of high trust in doctors and the internet separately for cancer-seeking information. Demographic predictor variables varied as predictors of high trust for cancer knowledge across both sources. Respondents who reported less confidence in their ability to seek cancer information had significantly higher odds of high trust in both doctors (OR = 8.43, CI: 5.58-12.73) and the internet (OR = 2.93, CI: 1.97-4.35) as compared to those who reported being "completely confident" in their ability to obtain cancer information. Understanding the key predictors of trust in doctors and the internet is crucial to the enhancement of health. The role of confidence as a predictor of trust in seeking cancer information has been shown to consistently influence the levels of trust attributed to each topic.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion Disease Prevention, University of Texas School of Public, Health, TX, Houston, 77030, USA
| | | | - Milad Khoury
- Department of Endocrinology, Penn State University, Hershey, PA, USA
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Tylee MJ, Rubenfeld GD, Wijeysundera D, Sklar MC, Hussain S, Adhikari NKJ. Anesthesiologist to Patient Communication: A Systematic Review. JAMA Netw Open 2020; 3:e2023503. [PMID: 33180130 PMCID: PMC7662141 DOI: 10.1001/jamanetworkopen.2020.23503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Many patients are admitted to the intensive care unit following surgery, and some of them will experience incomplete recovery. For patients in this situation, preoperative discussions regarding patient values and preferences may direct care decisions. Existing literature shows that it is uncommon for surgeons to have these conversations preoperatively; it is unclear whether anesthesia professionals engage with patients on this topic prior to surgery. OBJECTIVE To review the literature on communication between patients and anesthesia professionals, with a focus on discussions related to postoperative critical care. EVIDENCE REVIEW MEDLINE and Web of Science were searched using specific search criteria from January 1980 to April 2020. Studies describing encounters between patients and anesthesia professionals were selected, and data regarding study objectives, study design, methodology, measures, outcomes, patient characteristics, and clinical setting were extracted and collated. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. FINDINGS A total of 12 studies including 1284 individual patient encounters were eligible for inclusion in the review. These studies demonstrated that communication between patients and anesthesia professionals related to postoperative care is rare: only 2 studies reported communication regarding adverse postoperative events, and this communication behavior was reported in only 46 of 1284 consultations (3.6%) across all studies. Additional findings were that communication during these encounters is dominated by anesthetic planning and perioperative logistics, with variable discussion of perioperative risks vs benefits and infrequent elicitation of patient values and preferences. Some data suggest that patients wish to be involved in perioperative decision-making but are often limited by an incomplete understanding of risks and benefits. CONCLUSIONS AND RELEVANCE This systematic review found that communication in anesthesia is dominated by anesthetic planning and discussion of preoperative logistics, whereas postoperative critical care is rarely discussed. Most patients who are admitted to an intensive care unit after a major operation will not have had a discussion regarding goals of care specific to protracted recovery or prolonged intensive care with their anesthesiologist.
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Affiliation(s)
- Michael J. Tylee
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Gordon D. Rubenfeld
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Duminda Wijeysundera
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael C. Sklar
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Sajid Hussain
- Department of Intensive Care Medicine, King AbdulAziz Medical City, Riyadh, Saudi Arabia
| | - Neill K. J. Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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Hajebrahimi S, Janati A, Arab-Zozani M, Sokhanvar M, Haghgoshayie E, Siraneh Y, Bahadori M, Hasanpoor E. Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-05-2019-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeVisit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries.Design/methodology/approachMEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0.FindingsOf 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8,I2=81.27,p=0.891) and patients’ gender (Q=55.98, df=11,I2=80.35,p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5,I2=87.88,p=0.170).Originality/valueIn this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.
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Scholz V, Lange S, Rosenberg B, Kromrey ML, Syperek A, Hosten N, Kohlmann T, Kirsch M. Identifying communication-related predictors of patient satisfaction in a briefing prior to contrast-enhanced computed tomography. Insights Imaging 2019; 10:99. [PMID: 31549246 PMCID: PMC6757073 DOI: 10.1186/s13244-019-0778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to prospectively investigate patients' satisfaction with briefings before computed tomography (CT) examinations, determine feasibility, and identify factors influencing patient satisfaction independent of patient and physician characteristics. METHODS One hundred sixty patients received information by a radiologist prior to contrast-enhanced CT examinations in an open, prospective, two-center, cross-sectional study (including the introduction of the radiologist, procedure, radiation exposure, possible side effects, and alternatives). Afterwards, patients and radiologists evaluated the briefing using a standardized questionnaire. Additionally, factors such as age, socioeconomic status, inpatient/outpatient status, length of the radiologist's professional experience, duration of the briefing, clarity of the radiologist's explanations as perceived by patients, and the duration of communication were obtained in this questionnaire. Subsequently, three classes of influencing factors were defined and entered stepwise into a hierarchical regression. RESULTS Patient satisfaction ratings differed significantly by type of hospitalization, perceived type of communication, and patient gender. Hierarchical regression analysis revealed that perceived clarity was the strongest predictor of patients' satisfaction when controlling for the patient and physician characteristics. CONCLUSIONS Patients appeared to be satisfied with the briefing prior to CT examination. The mean briefing time (2 min 35 s) seemed feasible. Patients' demographics influenced satisfaction. To improve patients' satisfaction with briefings before contrast-enhanced CT, radiologists should aim to clarify their communication.
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Affiliation(s)
- Valentina Scholz
- Department of Diagnostic Radiology and Neuroradiology Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Sandra Lange
- Department of Diagnostic Radiology and Neuroradiology Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Britta Rosenberg
- Department of Diagnostic Radiology and Neuroradiology Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Marie-Luise Kromrey
- Department of Diagnostic Radiology and Neuroradiology Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Annika Syperek
- Department of Diagnostic Radiology and Neuroradiology Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Norbert Hosten
- Department of Diagnostic Radiology and Neuroradiology Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Thomas Kohlmann
- Section Methods in Community Medicine, Walther-Rathenau-Straße 48, Institute for Community Medicine, 17475, Greifswald, Germany
| | - Michael Kirsch
- Department of Diagnostic Radiology and Neuroradiology Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Jaensson M, Dahlberg K, Nilsson U. Factors influencing day surgery patients' quality of postoperative recovery and satisfaction with recovery: a narrative review. Perioper Med (Lond) 2019; 8:3. [PMID: 31139359 PMCID: PMC6530125 DOI: 10.1186/s13741-019-0115-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of healthcare services is to provide a high quality of care. One way to ensure that this aim has been fulfilled is to assess patients' satisfaction with their care. Although satisfaction is a complex concept, it is an important outcome in perioperative care. The objective of this paper is to discuss and reflect on factors that can affect patients' quality of postoperative recovery and satisfaction with recovery after day surgery. Involving patients in shared decision-making (SDM) and providing sufficient preoperative and postoperative information can improve their satisfaction. It is important to assess whether patients experience poor recovery, which can be both distressing and dissatisfying. We suggest that patients' age, sex, mental health status, and health literacy (HL) skills should be assessed preoperatively, since these factors seem to have a negative impact on patients' postoperative recovery. Identifying factors that have a negative impact on patients' quality of postoperative recovery and satisfaction with recovery after day surgery will assist healthcare professionals in supporting vulnerable patients, such as those with limited HL and poor mental health. Treating patients with respect and dignity and providing SDM can increase their quality of postoperative recovery and satisfaction with recovery.
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Affiliation(s)
- Maria Jaensson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Ulrica Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute and Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Azzez SS, Abdulah DM, Piro RS, Miho Alhakem SS. Sleep severity and fatigue manifestations in relation to the doctor-patient relationship. Sleep Med 2019; 58:13-17. [PMID: 31042620 DOI: 10.1016/j.sleep.2019.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/21/2019] [Accepted: 02/08/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The doctor-patient relationship has an important role in the delivery of high-quality healthcare. The aim of the present study was to explore and evaluate the impact of sleep severity and fatigue manifestations on doctor-patient relationships. METHODS The present study was an analysis of a cross-sectional sample of a total of 123 physicians with different specialties and work in various shifts in Iraq. Sleep severity difficulty was measured by Athens Insomnia Scale (AIS) in accordance with the International Classification of Diseases (ICD-10) and the multidimensional nature of fatigue was assessed by the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Moreover, the doctor-patient relationship was measured by Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10). RESULTS In this study, nearly half of the physicians (45.5%) were insomniacs. The total fatigue score was 9.46; general fatigue (Mean (M): 5.84 of 24); physical fatigue (M: 5.15 of 24); emotional fatigue (M: 6.04 of 24); mental fatigue (M: 5.45 of 24); and vigor (M: 12.98 of 24). The doctors felt slight irritation in their communications with patients (M: 2.33); had moderate dysphoria (M: 3.37); had slight compliance in their communications (M: 1.71), and slightly considered patients to be self-destructive (M: 1.97). In addition, the study showed that general and physical fatigue, night shift-work, and increased working hours in the public sector were predictors for doctors finding their patient irritating. Similarly, increased working hours by clinicians in the public sector was a predictor for having less compliance in their relationships with patients. CONCLUSION The present investigation suggests that insomnia has an indirect association with negative categories of the doctor-patient relationship.
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Chapman CH, Heath G, Fairchild P, Berger MB, Wittmann D, Uppal S, Tolpadi A, Maturen K, Jolly S. Gynecologic radiation oncology patients report unmet needs regarding sexual health communication with providers. J Cancer Res Clin Oncol 2018; 145:495-502. [PMID: 30539283 DOI: 10.1007/s00432-018-2813-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Following radiation therapy (RT), women with gynecologic malignancies report high rates of sexual dysfunction, but little is known regarding sexual health communication between these patients and health-care providers. This study assessed these patients' beliefs/attitudes toward providers' sexual history taking. METHODS Surveys were administered to women who presented for follow-up care for gynecologic cancers in an academic radiation oncology department. The surveys assessed patient sexual health beliefs and inquiry preferences. Sexual functioning was assessed using the Female Sexual Function Index (FSFI). Ordered logistic regressions were performed to assess for correlations between survey responses, FSFI, and demographic characteristics. RESULTS Seventy-five subjects participated. Most (89.8%) had FSFI scores indicating sexual dysfunction. Most patients agreed that sexual function is an important component of overall health (78.7%) and that providers should inquire regularly (62.8%). Few (12.0%) reported embarrassment around provider discussions. Most (62.7%) preferred discussion with female providers, especially married patients (p = 0.03). Half (53.4%) agreed that sexual problems are an unavoidable part of aging, a view that was more common as education level decreased (p = 0.01). Most (62.7%) patients agreed that providers should regularly ask about their sexual history, with patients having significant differences in education level. Patients with low FSFI scores were less likely to report inquiry from their OB/Gyn (p = 0.03). CONCLUSIONS Gynecologic cancer radiotherapy patients want to discuss sexual health, but report suboptimal provider inquiry. Patient views and experiences varied based on marital status, education level, and FSFI score. This work highlights the need for improved sexual health communication between cancer patients and providers.
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Affiliation(s)
- Christina Hunter Chapman
- Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Gerard Heath
- Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Pamela Fairchild
- Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mitchell B Berger
- Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Daniela Wittmann
- Department of Urology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Shitanshu Uppal
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anagha Tolpadi
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Katherine Maturen
- Department of Radiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Unal O, Akbolat M, Amarat M. The influence of patient-physician communication on physician loyalty and hospital loyalty of the patient. Pak J Med Sci 2018; 34:999-1003. [PMID: 30190769 PMCID: PMC6115559 DOI: 10.12669/pjms.344.15136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Patient-physician communication is important for an effective healthcare service and for the patient’s development of loyalty to the hospital. In this regard, this study aimed to determine whether there is a relationship between the patient-physician communication, the loyalty of the patient to the physician and to the hospital. Also study aimed to determine whether there is a mediating role of the physician loyalty on the patient-physician communication effect on to the hospital loyalty. Method: Five hundred ten questionnaires were distributed to regular public patients of the government hospitals, clinics, and private clinic patients in Sakarya using a simple random sampling method. Data were analysed using descriptive statistics and Structural Equation Modelling (SEM). Results: According to the findings, there was a significant relationship between patient-physician communication and loyalty to physician and to hospital. Patient-physician communication has a significant effect on loyalty to physician and hospital. In addition, patient loyalty has a mediating role on the patient-physician communication effect on the hospital loyalty. Conclusion: According to the result of the study, physician-patient communication could be used as an important tool in creating physician loyalty and hospital loyalty. This study helps physicians and health service providers to formulate strategies and tactics that will effectively develop the loyalty of patients.
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Affiliation(s)
- Ozgun Unal
- Ozgun Unal, PhD Student. Department of Health Care Management, Sakarya University, Sakarya, Turkey
| | - Mahmut Akbolat
- Dr. Mahmut Akbolat, Associate Professor, Department of Health Care Management, Sakarya University, Sakarya, Turkey
| | - Mustafa Amarat
- Mustafa Amarat, PhD Student. Department of Health Care Management, Sakarya University, Sakarya, Turkey
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Cioffi JM. Collaborative care: Using six thinking hats for decision making. Int J Nurs Pract 2017; 23. [PMID: 28976053 DOI: 10.1111/ijn.12593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
AIM To apply six thinking hats technique for decision making in collaborative care. BACKGROUND In collaborative partnerships, effective communications need to occur in patient, family, and health care professional meetings. The effectiveness of these meetings depends on the engagement of participants and the quality of the meeting process. The use of six thinking hats technique to engage all participants in effective dialogue is proposed. DESIGN Discussion paper. DATA SOURCES Electronic databases, CINAHL, Pub Med, and Science Direct, were searched for years 1990 to 2017. IMPLICATIONS FOR NURSING Using six thinking hats technique in patient family meetings nurses can guide a process of dialogue that focuses decision making to build equal care partnerships inclusive of all participants. Nurses will need to develop the skills for using six thinking hats technique and provide support to all participants during the meeting process. CONCLUSION Collaborative decision making can be augmented by six thinking hat technique to provide patients, families, and health professionals with opportunities to make informed decisions about care that considers key issues for all involved. Nurses who are most often advocates for patients and their families are in a unique position to lead this initiative in meetings as they network with all health professionals.
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Affiliation(s)
- Jane Marie Cioffi
- School of Nursing and Midwifery, University of Western Sydney (retired since submission of paper), Sydney, NSW, Australia
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Palaganas JC, Fey M, Simon R. Structured Debriefing in Simulation-Based Education. AACN Adv Crit Care 2017; 27:78-85. [PMID: 26909457 DOI: 10.4037/aacnacc2016328] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Debriefing following a simulation event is a conversational period for reflection and feedback aimed at sustaining or improving future performance. It is considered by many simulation educators to be a critical activity for learning in simulation-based education. Deep learning can be achieved during debriefing and often depends on the facilitation skills of the debriefer as well as the learner's perceptions of a safe and supportive learning environment as created by the debriefer. On the other hand, poorly facilitated debriefings may create adverse learning, generate bad feelings, and may lead to a degradation of clinical performance, self-reflection, or harm to the educator-learner relationship. The use of a structure that recognizes logical and sequential phases during debriefing can assist simulation educators to achieve a deep level of learning.
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Affiliation(s)
- Janice C Palaganas
- Janice C. Palaganas is Director of Educational Innovation and Development, Center for Medical Simulation, 100 First Avenue, Suite 400, Boston, MA 02129 . Mary Fey is Research Fellow, Center for Medical Simulation, Boston, Massachusetts. Robert Simon is Senior Director, Educational Leadership and International Programs, Center for Medical Simulation, Boston, Massachusetts
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Svensson M, Nilsson U, Svantesson M. Patients' experience of mood while waiting for day surgery. J Clin Nurs 2016; 25:2600-8. [DOI: 10.1111/jocn.13304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Margita Svensson
- Faculty of Medicine and Health; School of Health Sciences; Örebro University; Örebro Sweden
| | - Ulrica Nilsson
- Faculty of Medicine and Health; School of Health Sciences; Örebro University; Örebro Sweden
| | - Mia Svantesson
- Faculty of Medicine and Health; Örebro University; Örebro Sweden
- University Health Care Research Center; Region Örebro County; Örebro Sweden
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Hemanth Kumar VR, Jahagirdar SM, Ravishankar M, Athiraman UK, Maclean J, Parthasarathy S. Perioperative communication practices of anesthesiologists: A need to introspect and change. Anesth Essays Res 2016; 10:223-6. [PMID: 27212751 PMCID: PMC4864671 DOI: 10.4103/0259-1162.167848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: We conducted an audit of various communication practices during perioperative care among anesthesiology resident (R), faculties (F), and private practitioners (PP) in South India. We also documented the level of psycho-social support given to the patient and patient relatives and communication with the surgical colleagues during perioperative care. Methodology: A 15-point questionnaire based on communication practices was distributed in three major anesthesiology conferences requesting anesthesiologists to answer and drop the forms in the drop box provided. Resident and consultant level anesthesiologists of various Medical Schools in South India and private practitioners were involved in the study. The answers were analyzed to find out the various communication practices in perioperative care. Results: The freelancing private practitioners (PP) were more communicative to patient and relatives especially in complicated cases (Q1 - 45.6%, Q2 - 97.8%, Q4 - 94.4%, Q8 - 98.9%, respectively) in comparison with institutionalized practitioners. The choice of anesthesia and discussion related to the advantages of one mode of anesthesia over other was the most neglected part of communication (R - 14.2%, F - 17.6%, and PP - 5.6%). The PP's (95.6%) are more concerned about intraoperative communication (R - 27.6%, F - 39.2%). The discussion of postoperative pain management plan with the surgeon is not given priority in the communication by postgraduates (7.9%) and teaching faculties (8.8%). Conclusion: There is an urgent need to introspect and change the communication practices. We strongly recommend that communications skills should be introduced in anesthesiology resident curriculum.
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Affiliation(s)
- V R Hemanth Kumar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, Tamil Nadu, India
| | - Sameer Mahamud Jahagirdar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, Tamil Nadu, India
| | - M Ravishankar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, Tamil Nadu, India
| | | | - Jennyl Maclean
- Department of Forensic Medicine, Kanyakumari Medical College, Kanyakumari, Tamil Nadu, India
| | - S Parthasarathy
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, Tamil Nadu, India
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Ernesäter A, Engström M, Winblad U, Rahmqvist M, Holmström IK. Telephone nurses' communication and response to callers' concern—a mixed methods study. Appl Nurs Res 2016; 29:116-21. [DOI: 10.1016/j.apnr.2015.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
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21
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Maatouk-Bürmann B, Ringel N, Spang J, Weiss C, Möltner A, Riemann U, Langewitz W, Schultz JH, Jünger J. Improving patient-centered communication: Results of a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2016; 99:117-24. [PMID: 26490488 DOI: 10.1016/j.pec.2015.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Patient-centered communication is a key element for improving the quality of care in terms of therapeutic relationship, patient participation, and treatment process. Postgraduate trainings provide an essential way of promoting patient centeredness on the job where learning opportunities are often limited by time, patient volume, and economic pressure. In the present study, changes in patient centeredness during clinical routines of postgraduate physicians (internal medicine) after a three-day communication training were assessed. METHODS A randomized controlled trial was conducted in a primary care clinic. The intervention consisted of a communication training that aimed to enhance patient centeredness in postgraduate physicians. The training was based on a need assessment and the principles of deliberate practice. Workplace-based assessment of physicians' communication behavior was obtained using the Roter Interaction Analysis System. RESULTS Three months after the intervention, trained physicians showed significantly increased patient centeredness (F=5.36, p=.04; d=0.42). CONCLUSION The communication training significantly improved patient centeredness during routine clinical practice. Thus, this training provides a structured and theory-based concept to foster patient centeredness. PRACTICE IMPLICATIONS The results support the implementation of communication trainings as a part of faculty development and medical specialization training.
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Affiliation(s)
- Barbara Maatouk-Bürmann
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany.
| | - Nadja Ringel
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jochen Spang
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Carmen Weiss
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Möltner
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Urs Riemann
- Department of Internal Medicine I, SLK Clinic Heilbronn, Germany
| | - Wolf Langewitz
- Division of Psychosomatic Medicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jana Jünger
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
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Pires CM, Cavaco AM. Communication between health professionals and patients: review of studies using the RIAS (Roter Interaction Analysis System) method. Rev Assoc Med Bras (1992) 2015; 60:156-72. [PMID: 24919004 DOI: 10.1590/1806-9282.60.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 08/30/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Systematic review of studies that investigate the communication between patients and health professionals with the application of the RIAS methodology. METHODS Keyword Roter Interaction Analysis System was searched in the following bibliographic resources: Academic Search Complete, Current Contents, ISI Proceedings, PubMed, Elsevier, SpringerLink, Web of Science, RCAAP, Solo and the official RIAS site. Selection period: 2006 to 2011. Studies were selected using multicriteria dichotomous analysis and organized according to PRISMA. RESULTS Identification of 1,262 articles (455 unrepeated). 34 articles were selected for analysis, distributed by the following health professions: family medicine and general practitioners (14), pediatricians (5), nurses (4), geneticists (3), carers of patients with AIDS (2), oncologists (2), surgeons (2), anesthetists (1) and family planning specialists (1). The RIAS is scarcely used and publicized within the scope of healthcare in Portuguese speaking countries. DISCUSSION Main themes studied include the influence of tiredness, anxiety and professional burnout on communication and the impact of specific training actions on professional activities. The review enabled the identification of the main strengths and weaknesses of synchronous and dyadic verbal communication within the provision of healthcare. CONCLUSION Scientific investigation of the communication between health professionals and patients using RIAS has produced concrete results. An improvement is expected in health outcomes through the application of the RIAS.
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BURKLE CM, MANN CE, STEEGE JR, STOKKE JS, JACOB AK, PASTERNAK JJ. Patient fear of anesthesia complications according to surgical type: potential impact on informed consent for anesthesia. Acta Anaesthesiol Scand 2014; 58:1249-57. [PMID: 25307710 DOI: 10.1111/aas.12413] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Past research has explored patients' expectations about the informed consent process. However, it is currently unknown if the complexity of the surgical procedure influences the type of anesthesia-related risks that patients wish disclosed. This study explored fears of anesthesia-related complications and whether these changed based on severity of surgery classification. METHODS Patients presenting to our pre-operative evaluation clinic from February 2013 to May 2013 were asked to participate in a survey-based study meant to evaluate their perception of five possible anesthetic risks (peripheral nerve injury, death, nausea and vomiting, heart attack and stroke) when confronted with differing levels of surgical severity. RESULTS One thousand surveys were administered, and 894 were returned for an overall response rate of 89%. Fear of death was the greatest concern as compared to the other risk factors independent of the severity of surgery. The level of fear for all risk factors, with the exception of stroke and heart attack, were dependent on the severity of surgery. Fear of death decreased as the severity of surgery decreased (major 46%, moderate 38%, minor 25%). For major surgery, the fear of perioperative death differed significantly with age (P < 0.001); specifically, with increasing age came a lessened fear of death. CONCLUSION Awareness by anesthesia providers of those fears that patients report may allow for a more personalized approach to providing information that may better allay anxiety. Further, these results may better tailor the informed consent process to one that meets particular patient concerns.
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Affiliation(s)
- C. M. BURKLE
- Department of Anesthesiology; Mayo Clinic; Rochester MN USA
| | - C. E. MANN
- Department of Anesthesiology; Mayo Clinic; Rochester MN USA
| | - J. R. STEEGE
- Department of Anesthesiology; Mayo Clinic; Rochester MN USA
| | - J. S. STOKKE
- Department of Anesthesiology; Mayo Clinic; Rochester MN USA
| | - A. K. JACOB
- Department of Anesthesiology; Mayo Clinic; Rochester MN USA
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Liebenhagen A, Forsberg A. The courage to surrender--placing one's life in the hands of the other. J Perianesth Nurs 2014; 28:271-82. [PMID: 24054452 DOI: 10.1016/j.jopan.2012.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/23/2012] [Accepted: 12/04/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to investigate how adult patients experience and cope with the anesthesia induction period, that is, before and during total intravenous induction. DESIGN Grounded theory, based on the Charmaz framework, was used to explore what it is that characterizes patients' thoughts and feelings in this situation and how they handle the time period up to loss of consciousness. METHODS Patients were interviewed using an open-ended method. FINDINGS The core category: Constructing a foundation for surrendering one's life into the hands of the other illustrates the main concern of the 17 informants. This concern is illuminated by three main categories: Preparing oneself to surrender, trying to retain control, and accepting and surrendering/Refusing to accept and not surrendering. The informants struggled to place their life in the nurse anesthetist's/anesthesiologist's hands in a cycle of circumspection, preemption, and control. CONCLUSIONS In order to enable a dignified surrender, it is essential that the nurse anesthetist/anesthesiologist understands the patient's experience of loss of control.
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Björkman B, Golsäter M, Simeonson RJ, Enskär K. Will it hurt? Verbal interaction between child and radiographer during radiographic examination. J Pediatr Nurs 2013; 28:e10-8. [PMID: 23619022 DOI: 10.1016/j.pedn.2013.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 03/22/2013] [Accepted: 03/23/2013] [Indexed: 11/17/2022]
Abstract
This study investigated the nature of verbal interactions between child, parent and radiographer and the extent to which it varied as a function of the child's age. The participants were 20 female radiographers and 32 children (3-15 years) examined for acute injuries. The verbal interactions during the examination were video recorded and analyzed using the Roter Interaction Analysis System (RIAS). Results indicated that 80% of the verbal interaction was accounted for by the radiographer, 17% by the child and 3% by the parent. The distribution of utterances varied with regard to children's age.
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Affiliation(s)
- Berit Björkman
- CHILD Research Group, Research School of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden.
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Leal-Blanquet J, Alentorn-Geli E, Ginés-Cespedosa A, Martínez-Díaz S, Cáceres E, Puig L. Effects of an educational audiovisual videodisc on patients' pre-operative expectations with total knee arthroplasty: a prospective randomized comparative study. Knee Surg Sports Traumatol Arthrosc 2013; 21:2595-602. [PMID: 22878435 DOI: 10.1007/s00167-012-2158-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/25/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the effectiveness of an educational videodisc in modifying pre-operative patients' expectations with total knee arthroplasty (TKA) and to find a biophysical profile of subjects in whom this videodisc could be most effective. It was hypothesized that patients receiving standard information plus additional medical information through audiovisual videodiscs would modify their pre-operative expectations more than those only receiving the standard information through medical interviews. METHODS Ninety-two patients (age, 50-90 years) with knee osteoarthritis waiting for TKA were randomized into two groups. All patients received general verbal information about this procedure. Forty-two patients (study group) additionally viewed an educational videodisc related to the whole process of TKA, whereas 50 patients did not view it (control group). Patients completed baseline and post-videodisc questionnaires regarding their expected results after TKA. RESULTS Expectations with TKA were not modified by the audiovisual videodisc, except for knee range of motion and use of stairs. There were no differences in change of expectations between groups depending on demographic, functional, health, emotional, and cognitive variables, except for body mass index. The overall pre-operative, pre-intervention expectations were not modified by the audiovisual videodisc. CONCLUSIONS Based on these results, the use of this complementary tool may not be systematically recommended. In addition, it was not possible to identify a biophysical profile of patients in whom the intervention could be most effective.
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Affiliation(s)
- Joan Leal-Blanquet
- Department of Orthopaedic Surgery, Hospital del Mar i l'Esperança-Parc de Salut MAR, Carrer Sant Josep de la Muntanya 12, 08024, Barcelona, Spain,
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Abstract
The number of patients treated by elective day-case surgery in the UK is growing. Patient preoperative anxiety can be considerable, although the opportunity to help to reduce fears is minimal. Day surgery patients (n = 674) were surveyed and 82% were found to be anxious. General anaesthesia patients were more anxious than local anaesthesia patients and females more anxious than males. The results indicate that general anaesthesia patients may require more preoperative information, and gender differences associated with waiting may need to be given greater consideration.
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Affiliation(s)
- Mark Mitchell
- School of Nursing, Midwifery & Social Work, Room 166, Mary Seacole Building, University of Salford, Salford, M5 4WT.
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Gillies A, Gillies R, Weinberg L. Patient recollections of perioperative anaesthesia risks. Anaesth Intensive Care 2013; 41:247-50. [PMID: 23530792 DOI: 10.1177/0310057x1304100214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is widespread variation as to the method of presentation of informed anaesthetic consent with little empirical data on the nature of communication and how much information is retained. At a dedicated anaesthesia pre-admission clinic, 149 patients undergoing elective surgery under general anaesthesia were both verbally informed and shown written information about four major and three minor anaesthesia risks. The major risks were death, pneumonia, heart attack and stroke. The minor risks were dental damage, nausea and vomiting. On the day of scheduled surgery, retention of information about these anaesthetic risks was examined. Thirty-eight patients (26%) could not recall any anaesthesia risks, 55 patients (37%) could not recall any major risks and 126 patients (84%) could not recall any minor risks. Our findings indicate that patients should receive a second explanation on the day of surgery, even if informed consent was provided only two weeks earlier.
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Affiliation(s)
- A Gillies
- Department of Anaesthesia, Maroondah Hospital, Victoria, Australia
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Couët N, Desroches S, Robitaille H, Vaillancourt H, Leblanc A, Turcotte S, Elwyn G, Légaré F. Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expect 2013; 18:542-61. [PMID: 23451939 DOI: 10.1111/hex.12054] [Citation(s) in RCA: 332] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. OBJECTIVE To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. SEARCH STRATEGY We conducted online literature searches in multiple databases (2001-12) and gathered further data through networking. INCLUSION CRITERIA (i) OPTION scores as reported outcomes and (ii) health-care providers and patients as study participants. For analysis, we only included studies using the revised scale. DATA EXTRACTION Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting. MAIN RESULTS We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient-involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0-100 scale). When assessed, the variables most consistently associated with higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15). CONCLUSIONS Whatever the clinical context, few health-care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this.
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Affiliation(s)
- Nicolas Couët
- Department of Social and Preventive Medicine, Université Laval, Québec City, QC, Canada
| | - Sophie Desroches
- Department of Food and Nutrition Sciences, Université Laval, Québec City, QC, Canada.,Institute of Nutraceuticals and Functional Foods (INAF), Québec City, QC, Canada
| | - Hubert Robitaille
- Research Center of the Centre Hospitalier Universitaire de Québec, Hôpital St-François-D'Assise, Québec City, QC, Canada
| | - Hugues Vaillancourt
- Institute of Nutraceuticals and Functional Foods (INAF), Québec City, QC, Canada
| | - Annie Leblanc
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Stéphane Turcotte
- Research Center of the Centre Hospitalier Universitaire de Québec, Hôpital St-François-D'Assise, Québec City, QC, Canada
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Hanover, NH, USA
| | - France Légaré
- Research Center of the Centre Hospitalier Universitaire de Québec, Hôpital St-François-D'Assise, Québec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC, Canada
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Vaillancourt H, Légaré F, Lapointe A, Deschênes SM, Desroches S. Assessing patients' involvement in decision making during the nutritional consultation with a dietitian. Health Expect 2012; 17:545-54. [PMID: 22512818 DOI: 10.1111/j.1369-7625.2012.00783.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) represents an interesting approach to optimize the impact of dietary treatment, but there is no evidence that SDM is commonly integrated into diet-related health care. OBJECTIVE To assess the extent to which dietitians involve patients in decisions about dietary treatment. METHODS We audiotaped dietitians conducting nutritional consultations with their patients, and we transcribed the tapes verbatim. Three trained raters independently evaluated the content of the nutritional consultations using a coding frame based on the 12 items of the French-language version of the OPTION scale, a validated and reliable third-observer instrument designed to assess patients' involvement by examining specific health professionals' behaviours. Coding was facilitated by the qualitative research software NVivo 8. We assessed internal consistency with Cronbach's alpha and inter-rater reliability with the intraclass correlation coefficient (ICC). RESULTS Of the 40 dietitians eligible to participate in the study, 19 took part. We recruited one patient per participating dietitian. The overall mean OPTION score was 29 ± 8% [range, 0% (no patient involvement in the decision] to 100% [high patient involvement)]. The mean duration of consultations was 50 ± 26 min. The OPTION score was positively correlated with the duration of the consultation (r = 0.65, P < 0.01). Internal consistency and inter-rater reliability were both good (Cronbach's alpha = 0.72; ICC = 0.65). CONCLUSION This study is the first to use a framework based on the OPTION scale to report on dietitians' involvement of patients in decisions about patients' dietary treatment. The results suggest that involvement is suboptimal. Interventions to increase patients' involvement in diet-related decision making are indicated.
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Affiliation(s)
- Hugues Vaillancourt
- Research Assistant, Institute of Nutraceuticals and Functional Foods (INAF), Laval University, Quebec City, QCAffiliated Researcher, CHUQ Research Center (Centre Hospitalier Universitaire de Québec - Hôpital St-François-d'Assise),Associate Professor, Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC,Associate Professor, Department of Food and Nutrition Sciences, Faculty of Agriculture and Food Sciences, Laval University, Quebec City, QC,Affiliated Researcher, Institute of Nutraceuticals and Functional Foods (INAF), Laval University, Quebec City, QC, Canada
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Nicolai J, Moshagen M, Eich W, Bieber C. The OPTION scale for the assessment of shared decision making (SDM): methodological issues. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2012; 106:264-71. [PMID: 22749073 DOI: 10.1016/j.zefq.2012.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Promoting patient involvement in medical decision making has become a desirable goal in medical consultations. Reliable and valid measures are necessary to evaluate interventions designed to promote shared decision making and to understand determinants and associations. The OPTION ("observing patient involvement") scale is the most prominent observation instrument for assessing the extent to which clinicians actively involve patients in decision making. OBJECTIVE This paper discusses psychometric and methodological characteristics of the OPTION scale. RESULTS There is little support for the purported unidimensional structure. Although reliabilities are acceptable, results are highly heterogeneous across studies. There is also little evidence concerning validity. In particular, studies mainly failed to support convergent validity. Additional issues pertain to lack of item independence, restriction of range, and failure to consider dyadic aspects. CONCLUSIONS Given these findings, a number of methodological and conceptual issues still need to be addressed for the effective measurement of patient involvement. Directions for future research are discussed.
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Affiliation(s)
- Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany.
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Kim JH. Preoperative evaluation of a surgical patient; preanesthetic interview by anesthesiology residents. Korean J Anesthesiol 2012; 62:207-8. [PMID: 22474544 PMCID: PMC3315647 DOI: 10.4097/kjae.2012.62.3.207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae Hwan Kim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Kim D, Lee SN, Kim DC, Lee J, Ko S, Lee SK, Son JS. The preanesthetic interview by anesthesiology residents: analysis of time and content. Korean J Anesthesiol 2012; 62:220-4. [PMID: 22474546 PMCID: PMC3315649 DOI: 10.4097/kjae.2012.62.3.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/03/2011] [Accepted: 08/09/2011] [Indexed: 11/17/2022] Open
Abstract
Background A preanesthetic visit can increase a patient's satisfaction. However, it is uncertain whether a preanesthetic visit by an anesthesiology resident can achieve the goal. We studied the time distribution for content of preanesthetic interviews (PI) and evaluated the patient's satisfaction with the PI. Methods We recorded the PI duration of 200 patients by a voice recorder. The degrees of patient satisfaction with the PI and the changes of anxiety level after the PI were quantified by a questionnaire. We analyzed the time distribution for content of the PI and the correlation between patient characteristics and PI duration or a patient's satisfaction. Results The total PI duration was 184 (134-286) sec (median, 25-75%), and the time distributions for content of the PI were 8 (5-10) of greeting, 45 (23-70) of history taking, 15 (10-20) of physical examination, 50 (25-98) for obtainingan informed consent, 20 (10-30) of explanation for anesthetic planning, 15 (5-28) for explanation of patient controlled analgesia, and 10 (0-4) sec for questions and answers. Age, ASA physical status, and educational level were correlated with PI duration (P < 0.001). The patient's level of satisfaction was "very satisfied" in 39%, "satisfied" in 50%, and "moderate" in 11% of interviews. The anxiety level was "decreased" in 50%, "increased" in 8%, and "not changed" in 42% of patients. Conclusions Although the duration of a PI given by residents was a relatively short, 89% of patients of were satisfied with the interview. The PI took a longer time to complete in patients of older age, higher ASA physical status, or lower educational levels.
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Affiliation(s)
- Deokkyu Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Brinkman WB, Hartl J, Rawe LM, Sucharew H, Britto MT, Epstein JN. Physicians' shared decision-making behaviors in attention-deficit/hyperactivity disorder care. ACTA ACUST UNITED AC 2011; 165:1013-9. [PMID: 22065181 DOI: 10.1001/archpediatrics.2011.154] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To describe the amount of shared decision-making (SDM) behavior exhibited during treatment-planning encounters for children newly diagnosed as having attention-deficit/hyperactivity disorder and to explore relationships between participant characteristics and the amount of SDM. DESIGN Prospective cohort study. SETTING Seven community-based primary care pediatric practices in the Cincinnati, Ohio; northern Kentucky; and southeast Indiana regions from October 5, 2009, through August 9, 2010. PARTICIPANTS Ten pediatricians and 26 families with a 6- to 10-year-old child newly diagnosed as having attention-deficit/hyperactivity disorder. OUTCOME MEASURE The amount of SDM behavior exhibited during videorecorded encounters, as coded by 2 independent raters using the validated Observing Patient Involvement (OPTION) scale, which was adapted for use in pediatric settings and produces a score ranging from 0 (no parental involvement) to 100 (maximal parental involvement). RESULTS Treatment decisions focused on initiation of medication treatment. The mean (SD) total OPTION score was 28.5 (11.7). More SDM was observed during encounters involving families with white vs nonwhite children (adjusted mean difference score, 14.9; 95% confidence interval [CI], 10.2-19.6; P < .001), private vs public health insurance coverage (adjusted mean difference score, 15.1; 11.2-19.0; P < .001), mothers with at least some college education vs high school graduate or less (adjusted mean difference score, 12.3; 7.2-17.4; P < .001), and parents who did not screen positive for serious mental illness vs those who did (adjusted mean difference score, 15.0; 11.9-18.1; P < .001). CONCLUSIONS Low levels of SDM were observed. Exploratory analyses identified potential disparities and barriers. Interventions may be needed to foster SDM with all parents, especially those of nonwhite race, of lower socioeconomic status, of lower educational level, and with serious mental illness.
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Affiliation(s)
- William B Brinkman
- Department of Pediatrics, Center for Innovation in Chronic Disease Care, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Abstract
AIM To investigate the possible influence of gender and anaesthesia type on anxiety prior to day surgery. BACKGROUND Elective surgery undertaken on a day, short stay or 'day of surgery' basis is growing and much emphasis also placed on 'enhanced recovery' for in-patient surgery. During such brief episodes preoperative apprehension can be considerable but the opportunity to help reduce anxiety is minimal and formal plans uncommon. METHOD As part of a larger study, a questionnaire was distributed to 1606 patients undergoing day surgery, with anaesthesia (2005-2007). Participants were requested to return the questionnaire by mail 24-48 hours following surgery, with 674 returned. Data were analysed using descriptive statistics and multivariate analysis of variance. RESULTS Of the total patients 82·4% experienced anxiety on the day of surgery with the wait, anaesthesia and possible pain being common anxiety-provoking aspects. The majority preferred to receive information between 1-4 weeks in advance and participants experiencing general anaesthesia required information at a statistically significantly earlier stage. General anaesthesia patients were statistically significantly more anxious than local anaesthesia patients and desired more information. Female patients were statistically significantly more anxious, anxiety commenced earlier and they preferred to wait with a relative/friend or talk with other patients. CONCLUSIONS Anxiety was experienced by the majority of participants but was more prevalent amongst general anaesthesia and female patients. For general anaesthesia patients, a comprehensive level of information may be required a number of weeks prior to surgery and gender differences associated with the preoperative wait may require greater consideration.
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Affiliation(s)
- Mark Mitchell
- Mark Mitchell MSc PhD RN Senior Lecturer College of Health and Social Care, University of Salford, Greater Manchester, UK.
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Adudu OP, Onyeka TC, Kolawole IK, Desalu I, Ekumankama O. Appropriate practice of anesthesia: A plea for better training. Saudi J Anaesth 2011; 5:170-2. [PMID: 21804798 PMCID: PMC3139310 DOI: 10.4103/1658-354x.82788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The role of the anesthesiologist is often unknown among patients. But, the situation where the anesthesiologist is uncertain of his/her function gives more cause for concern. Methods: A questionnaire survey on the appraisal of anesthetic practices was carried out over 5 months using the style of clinical practice. Results: One-third of the anesthesiologists who responded to the survey attached little importance to the work they did by not communicating the same to their patients while 45.2% did not discuss the intraoperative findings with the surgeons. Although 57 (59.4%) of the respondents usually visit their patients on the ward preoperatively, only 16 (21.6%) discussed the proposed anesthetic procedure with the patients. Thirty-nine (40.2%) respondents claimed that they do not wear ward coats to the ward at the preoperative visit. Less than 20% consistently conducted a postoperative visit. The majority of the respondents would treat all patients as important, irrespective of social status, while 74.5% of them considered obtaining informed consent for anesthesia from patients as significantly important. Conclusion: The current practice of anesthesia has been found wanting in several aspects. Knowledgeable discussion by anesthesiologists with surgeons as well as enlightenment of patients and their relatives about their work will improve the quality of anesthesia care remarkably. Changes in the anesthesia training curriculum to reflect these deficiencies would be helpful.
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Affiliation(s)
- O P Adudu
- Department of Anesthesia, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
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Smith AF, Mishra K. Interaction between anaesthetists, their patients, and the anaesthesia team. Br J Anaesth 2010; 105:60-8. [PMID: 20551027 DOI: 10.1093/bja/aeq132] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Communication is a key skill for anaesthetic practice. The 'non-informational' aspects of communication, such as non-verbal elements and the degree to which the style of communication reflects the implied relationship between the sender and the recipient, are relevant to interactions both between anaesthetists and patients and to interactions with other members of staff in the team. Communication and interaction between members of the anaesthesia team in isolation has received less attention than communication in the operating theatre during surgery. Most aspects of such communication are informally learned and developed with experience. Studies of communication at induction of anaesthesia have used qualitative methods to identify a range of styles of talk. This is nominally directed at the patient but also serves to unite and co-ordinate the team to ensure the patient's smooth, safe progress into anaesthesia. In particular, the use of positive words and phrases seems to benefit patient comfort and safety. On emergence, a more limited range of communication styles is found. Handover of the recently anaesthetized patient to recovery room staff is often brief and distracted by concurrent patient-related activities. Both information about the patient, and responsibility for the patient's continuing care, have to be transferred. The handover event also serves as an opportunity to review the care the patient has received and plan for further progress. Anaesthetists and nurses use unspoken and implicit negotiation strategies to achieve the aims of handover without compromising future collaborative work. This is in contrast to the more formalized handover approaches in other safety-critical settings.
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Affiliation(s)
- A F Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK.
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Langewitz W, Heydrich L, Nübling M, Szirt L, Weber H, Grossman P. Swiss Cancer League communication skills training programme for oncology nurses: an evaluation. J Adv Nurs 2010; 66:2266-77. [PMID: 20636470 DOI: 10.1111/j.1365-2648.2010.05386.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of an evaluation of the effectiveness of a communication skills training programme for oncology nurses. BACKGROUND Clinical care for patients with cancer is increasingly being divided between nurses and physicians, with nurses being responsible for the continuity of patient care, and oncologists choosing and explaining the basics of anti-cancer therapy. Therefore, oncology nurses will profit from evidence-based communication skills training to allow them to perform in a professional way. METHODS Between 2003 and 2006 pre- and post-intervention videos of interviews with simulated patients were compared using the Roter Interaction Analysis System. Patient centeredness was assessed by counting segments of appropriate mutual responding to cues and by calculating length of uninterrupted patient speech. FINDINGS Appropriate empathic (1.6% vs. 3.2%), reassuring statements (2.3% vs. 3.4%), questions concerning psychosocial information (2.8% vs. 4.0%) increased statistically significantly; utterances containing medical information decreased on the part of nurses (17.8% vs. 13.3%) and patients (8.1% vs. 6.7%); and patients provided more psychosocial information (3.3% vs. 5.7%). The level of congruence and empathic responses to patients' emotional cues increased statistically significantly, as did the length of uninterrupted speech (3.7-4.3 utterances; all P < 0.05). CONCLUSION The communication skills training of the Swiss Cancer League could be used as a model to achieve substantial improvements in patient-centred communication. Sequence analysis of utterances from patient-provider interaction should be used to assess the amount of patient-centred talk.
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Affiliation(s)
- Wolf Langewitz
- Department of Psychosomatic Medicine/Internal Medicine, University Hospital Basle, Switzerland.
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Abstract
AIM This paper is a report of a study carried out to uncover the most anxiety-provoking aspects of general anaesthesia and determine what interventions may help to alleviate such anxiety. BACKGROUND General anaesthesia has proved to be highly anxiety-provoking. With the rise in elective day surgery, this aspect of patients' experience has become a prominent issue. Indeed, with brief hospital stays, limited contact with healthcare professionals, restricted formal anxiety management and the acute psychological impact of day surgery, such anxiety may be increasing. METHOD As part of a larger study, a questionnaire was given on the day of surgery to 1250 adult patients undergoing surgery with general anaesthesia over a two year period from 2005-2007. The issue examined was anxiety in relation to the environment, hospital personnel and general anaesthesia. Participants were requested to return the questionnaire by mail 24-48 hours following surgery, and 460 completed questionnaires were returned. FINDINGS A total of 85% of respondents experienced some anxiety on the day of surgery. Immediate preoperative experiences and concerns about unconsciousness were highly anxiety-provoking. Using factor analysis Preoperative Anaesthetic Information, Anaesthetic Catastrophising, Final Support, Personal Support, Imminence of Surgery, Possible Adverse Events and Final Preoperative Experiences were identified as central features. Multiple regression demonstrated Preoperative Anaesthetic Information, Anaesthetic Catastrophising and Imminence of Surgery were statistically significantly associated with an overall increased level of anxiety. CONCLUSIONS Focusing on the timely, formal delivery of information about anaesthesia management, emphasizing the notion of 'controlled unconsciousness' and dispelling misconceptions associated with general anaesthesia may help to limit patient anxiety.
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Affiliation(s)
- Mark Mitchell
- Faculty of Health and Social Care, University of Salford, UK.
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Lackner C, Burghofer K, Baschnegger H, Rall M, Zwissler B. Simulationstraining in der Akut- und Notfallmedizin. Notf Rett Med 2009. [DOI: 10.1007/s10049-009-1177-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Communication between anaesthesiologists and patients: how are we doing it now and how can we improve? Curr Opin Anaesthesiol 2009; 22:431-5. [PMID: 19434797 DOI: 10.1097/aco.0b013e32832a40fb] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to present and bring together the relatively small body of recent work on anaesthesiologist-patient communication. RECENT FINDINGS Anaesthesiologists and patients may have different 'agendas' during their consultations, with anaesthesiologists focusing more on information and patients more on the emotional aspects of care. As effective communication implies a two-way process, anaesthesiologists should be aware of this. Communication can make good use of written media, video, E-mail and telephone as well as face-to-face interaction. The content of communication, both verbal and nonverbal, is critical but much of this is learned informally despite the recent interest in teaching communication skills. Some recent studies have observed and described how communication is actually performed in practice and these are a useful starting point for reflection and experiment. The few studies to examine whether communication can improve outcomes for patients have all produced broadly positive findings. Communication with children, communicating about risk and dealing with the aftermath of anaesthetic disasters are also reviewed specifically. SUMMARY Communication between anaesthesiologists and patients is essential for effective clinical practice. Some practical suggestions are made and pointers to further reading given.
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Current world literature. Curr Opin Anaesthesiol 2009; 22:447-56. [PMID: 19417565 DOI: 10.1097/aco.0b013e32832cbfed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 February 2008 and 31 January 2009 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.
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Abstract
The amount of surgery undertaken on the conscious patient is increasing. However, many patients are anxious and resistant to such surgery. Patients (n = 214) were surveyed to determine their related apprehensions. Being awake, feeling or seeing the body cut open and experiencing pain all increased anxiety. The potential for insufficient information provision was also a source of concern. Formal management of intraoperative apprehension may help limit anxiety and expel apparent misapprehensions.
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Affiliation(s)
- Mark Mitchell
- School of Nursing, Faculty of Health and Social Care, University of Salford, Manchester.
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Lamiani G, Furey A. Teaching nurses how to teach: an evaluation of a workshop on patient education. PATIENT EDUCATION AND COUNSELING 2009; 75:270-273. [PMID: 19027259 DOI: 10.1016/j.pec.2008.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 09/10/2008] [Accepted: 09/17/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the effects of a patient education workshop on nurses: (1) communication skills; (2) Knowledge of patient-centered model, patient education process, and sense of preparedness to provide patient education. METHODS Fourteen nurses attended a 2-day workshop on patient education based on a patient-centered model. Data on communication skills were collected by means of pre-/post-written dialogues and analyzed with the Roter Interaction Analysis System (RIAS). Data of nurses' knowledge and sense of preparedness were collected through a post questionnaire comprised of 5-point Likert scale items. RESULTS Post-dialogues showed an increase in patient talking (P<0.001) and in patient-centered communication as indicated by the increase in Psychosocial exchanges (P=0.003) and Process exchanges (P=0.001). Nurses reported that the workshop increased "very much" their knowledge of the patient-centered model (mean=4.19) and patient education process (mean=4.69), and their sense of preparedness to provide patient education (P=0.001). CONCLUSIONS Data suggest the efficacy of the workshop in developing patient-centered communication skills and improving nurses' knowledge and preparedness to deliver patient education. PRACTICE IMPLICATIONS Training based on a patient-centered model and interactive learning methods should be implemented for nurses to improve their ability to deliver effective patient education.
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Affiliation(s)
- Giulia Lamiani
- Center for Nursing Excellence, Brigham and Women's Hospital, Boston, MA 02120, USA
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Abstract
OBJECTIVE To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care. STUDY DESIGN Physicians, nurses, social workers, and chaplains (n=50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS). RESULT Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD=P<0.005; RN=P<0.05), focused more on family's opinion and understanding (MD=P<0.01; RN=P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support. CONCLUSION Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.
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Ariño Lambea P, Castillo Monsegur J, Sala Serrab M, Cortada Almirall V, Escolano Villén F. [Patients' perception of certainty about decisions to undergo surgery and the relationship between certainty and prior information received]. ACTA ACUST UNITED AC 2009; 55:468-74. [PMID: 18982783 DOI: 10.1016/s0034-9356(08)70629-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the certainty of patients deciding whether or not to undergo a proposed operation and the relationship between the degree of certainty and the prior information received. METHODS A cross-sectional study was performed using the decisional conflict scale (DCS) to evaluate the degree of certainty of patients deciding to undergo surgery. A standardized questionnaire was used to obtain demographic data (age, sex, and level of education) and details about the information the patients had received regarding the surgical procedure. Patients were classified as certain or uncertain of their decision to undergo surgery according to the DCS score. A logistic regression model was constructed to adjust for confounding factors and to analyze the relationship between certainty and variables reflecting the information received by the patient. RESULTS A total of 358 patients were included. Thirty percent of the patients stated that they had not received prior information and 31.6% showed uncertainty in their decision. Younger men with a higher level of education felt more certain of their decision. After adjusting for age, sex, and level of education, we found that uncertainty was related to the perception of not having received enough prior information (odds ratio, 43; 95% confidence interval, 2.4-7.7). CONCLUSION The perception of certainty is clearly linked to patients' understanding of prior information received. The results show a need to improve the information given to patients--particularly to elderly patients and those with a low level of education.
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Affiliation(s)
- P Ariño Lambea
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Mar-Esperanza, IMAS, Barcelona.
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Impact of written information describing postoperative pain management on patient agreement with proposed treatment. Eur J Anaesthesiol 2008; 25:884-90. [PMID: 18652711 DOI: 10.1017/s0265021508004857] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Because patients who are to undergo surgery must give their consent to planned postoperative care, clear and complete information on postoperative pain management should be given. The aim of this quality-of-care study was to evaluate by inquiry the impact of written information describing postoperative pain management on the quality and type of information retained, and patient participation in discussing and agreeing to the postoperative pain management programme during the presurgical anaesthesiology consultation. METHODS Prospective before and after interventional surveys, each lasting 3 weeks and conducted at a 6-month interval (time required to prepare the written information), used a standardized anonymous questionnaire given to patients after the anaesthesiology consultation. Questions requiring a 'yes' or 'no' response assessed the quality of information and what information was retained by the patient, the extent of the patient's interaction during the discussion with the anaesthesiologist and his/her agreement with the postoperative pain management programme. RESULTS Among the 180 before-group patients included, 16.7% reported receiving verbal information during the anaesthesiology consultation, none retained all seven principal side-effects of morphine, 14.4% considered the information to be thorough, 20.6% understood it, 16.7% claimed that it had helped them participate in the discussion and 14.4% concurred with the postoperative pain management programme. Compared to the before inquiry, significantly higher percentages of the 107 after-group patients (given written information before the anaesthesiology consultation) responded as having received verbal information during the anaesthesiology consultation (57.0%), retained morphine's main side-effects (12.1%), deemed the information thorough (58.9%) and understandable (53.3%), had participated in the discussion (47.7%) and agreed with the postoperative pain management programme (51.4%). CONCLUSION Written information on postoperative pain management distributed before the presurgical anaesthesiology consultation improved the quality of information retained, facilitated discussion with the anaesthesiologist and patient agreement with the postoperative pain management programme.
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Benhamou D, Berti M, Brodner G, De Andres J, Draisci G, Moreno-Azcoita M, Neugebauer EAM, Schwenk W, Torres LM, Viel E. Postoperative Analgesic THerapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain 2007; 136:134-41. [PMID: 17703887 DOI: 10.1016/j.pain.2007.06.028] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 06/16/2007] [Accepted: 06/21/2007] [Indexed: 12/16/2022]
Abstract
Surveys evaluating pain in hospitals keep on showing that postoperative pain (POP) remains undertreated. At the time when guidelines are edited and organisational changes are implemented, more recent data are necessary to check the impact of these measures on daily practice and needs for improvement. This prospective, cross-sectional, observational, multi-centre practice survey was performed in 2004-2005 in 7 European countries. It was conducted in surgical wards of a randomised sample of hospitals. Data on POP management practices following surgery in adult in-patients were collected anonymously via a standardised multiple choice questionnaire. Among 1558 questionnaires received from 746 European hospitals, 59% were provided by anaesthetists and 41% by surgeons. There are no regular on-site staff training programmes on POP management in the institution for 34% of the respondents, patients are systematically provided with POP information before surgery for 48% of respondents; balanced analgesia following major surgery and regular administration of analgesics are largely used; 25% of respondents have specific written POP management protocols for all patients in their ward; 34% of respondents say that pain is not assessed and 44% say that pain scores are documented in the patient's chart. This largest ever performed survey confirms the extensive body of evidence that current POP management remains suboptimal and identifies needs for improvement on European surgical wards. However, the wide use of balanced analgesia and the regular administration of analgesics are indicators of ongoing change.
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Affiliation(s)
- Dan Benhamou
- AP-HP, Hôpital de Bicêtre, Département d'Anesthésie-Réanimation, F-94275 Le Kremlin-Bicêtre cedex, France.
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Abstract
In the past two decades, the rate of surgery in older people has increased more rapidly than the rate of aging of the population, so both a larger proportion and a greater number of older people are now undergoing surgery. This may partly reflect a cultural change in surgery and anaesthesia with respect to a greater willingness to undertake elective procedures in older people, although there remain areas where they have less access to surgery than do younger patients. For instance, older people are less likely to undergo operative procedures after a cancer diagnosis. Furthermore, in those who do have surgery, resection rate (i.e. curative therapy) is lower than in younger people with equivalent tumour stages, and even more so in older patients with COPD, cardiovascular disease or diabetes. This article explores the complex relationship between age and surgical outcome, provides an evidence-based overview of risk assessment and common postoperative problems in older people, and summarizes good practice points (at times necessarily pragmatic) for clinical management of the older surgical patient. There has been a substantial expansion in the literature examining risks, outcomes and interventions in older surgical patients since the previous review article of this subject published in this journal. Although we do not cover anaesthesia in older people, the review of that topic remains relevant. The American Society of Anaesthesiologists' Classification of Risk which illustrates that risk is disease- rather than age- based, is shown in Table 1. Most publications examine elective rather than emergency surgery in older people (with the exception of hip fracture), and this is reflected in the content of the paper.
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