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Arrow K, Burgoyne LL, Cyna AM. Implications of nocebo in anaesthesia care. Anaesthesia 2022; 77 Suppl 1:11-20. [DOI: 10.1111/anae.15601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/20/2022]
Affiliation(s)
- K. Arrow
- Women’s and Children’s Hospital North Adelaide SA Australia
| | - L. L. Burgoyne
- Women’s and Children’s Hospital North Adelaide SA Australia
| | - A. M. Cyna
- Women’s and Children’s Hospital North Adelaide SA Australia
- Discipline of Acute Care Medicine University of Adelaide Adelaide SA Australia
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Cutajar L, Miu M, Fleet JA, Cyna AM, Steen M. Antenatal education for childbirth: Labour and birth. Eur J Midwifery 2021; 4:11. [PMID: 33537613 PMCID: PMC7839135 DOI: 10.18332/ejm/120002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This study aimed to identify the way information is described and presented by childbirth educators during antenatal classes for expectant parents, and analyse the language structures used when discussing labour and birth. METHODS This cross-sectional study of antenatal education was conducted at a single tertiary referral centre for Maternity Care in Western Sydney, Australia. All childbirth educators (n=3) were recorded whilst providing information to parents during antenatal classes. Audio data were subsequently transcribed and then analysed by two researchers, independently categorising the various language structures and types of information provided. This is the second study in a series of antenatal education topics. RESULTS During the labour and birth class, information statements were the predominant language structure that was spoken with 241 of 655 statements; negative statements were the next most frequent at 119 while there were 79 positive statements. The second stage of labour had a greater proportion of negative statements for two educators, followed by information and positive statements combined. Misinformation statements were minimal for this topic however, and there was an absence of any statements discussing the rest period between contractions. CONCLUSIONS The findings further emphasise the need to examine the language used by health professionals when educating parents. Negative statements during antenatal education are still common despite research in other contexts suggesting that these are potentially unhelpful. Further research into the language and suggestions used during antenatal education is required to determine whether improved outcomes seen in other contexts are confirmed in the childbirth setting.
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Affiliation(s)
- Lisa Cutajar
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,Department of Women's and Children's Health, Birth Unit, Nepean Hospital, Penrith, Australia
| | - Michelle Miu
- Anaesthesia and Pain Management, Nepean Hospital, Penrith, Australia
| | - Julie-Anne Fleet
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Allan M Cyna
- Anaesthesia and Pain Management, Nepean Hospital, Penrith, Australia.,Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Mary Steen
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Li Ching Ng A, McRobb LS, White SJ, Cartmill JA, Cyna AM, Seex K. Consent for spine surgery: an observational study. ANZ J Surg 2020; 91:1220-1225. [PMID: 33021031 DOI: 10.1111/ans.16348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The tension between the ideal of informed consent and the reality of the process is under-investigated in spine surgery. Guidelines around consent imply a logical, plain-speaking process with a clear endpoint, agreement and signature yet surgeons' surveys and patient interviews suggest that surgeons' explanation is anecdotally variable and patient understanding remains poor. To obtain a more authentic reflection of practice, spine surgeons obtaining 'informed consent' for non-instrumented spine surgery were studied via video recording and risk/benefit discussions were analysed. METHODS A prospective observational study was conducted at a single neurosurgical institution. Twelve video recordings involving six surgeons obtaining an informed consent for non-instrumented spine surgery were transcribed verbatim and blindly analysed using descriptive quantification and linguistic ethnography. RESULTS Ten (83%) consultations discussed surgical benefit but less than half (41%) quantified the likelihood of benefit from surgery. The most discussed risks were nerve damage or paralysis (92%), bleeding (92%), infection (92%), cerebrospinal fluid leak (83%) and bowel and bladder dysfunction (75%). Surgeons commonly used a quantitative statement of risk (58%) but only half of the risks were explained in words patients were likely to understand. CONCLUSIONS This study highlights inconsistencies in the way spine surgeons explain risks and obtain informed consent for 'simple' spine procedures in a real-world setting. There are wide disparities in the provision of informed consent, which may be encountered in other surgical fields. Direct observation and qualitative analysis can provide insights into the limitations of current informed consent practice and help guide future practice.
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Affiliation(s)
- Angela Li Ching Ng
- Macquarie Neurosurgery, Macquarie University Clinic, Sydney, New South Wales, Australia
| | - Lucinda S McRobb
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah J White
- Department of Biomedical Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - John A Cartmill
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Allan M Cyna
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Kevin Seex
- Macquarie Neurosurgery, Macquarie University Clinic, Sydney, New South Wales, Australia
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Cutajar L, Cyna AM. Antenatal education for childbirth–epidural analgesia. Midwifery 2018; 64:48-52. [DOI: 10.1016/j.midw.2018.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
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Camann W. Pain, Pain Relief, Satisfaction and Excellence in Obstetric Anesthesia: A Surprisingly Complex Relationship. Anesth Analg 2018; 124:383-385. [PMID: 28098685 DOI: 10.1213/ane.0000000000001676] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- William Camann
- From the Department of Obstetric Anesthesiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Waisblat V, Langholz B, Bernard FJ, Arnould M, Benassi A, Ginsbourger F, Guillou N, Hamelin K, Houssel P, Hugot P, Martel-Jacob S, Moufouki M, Musellec H, Nid Mansour S, Ogagna D, Paqueron X, Zerguine S, Cavagna P, Bloc S, Jensen MP, Dhonneur G. Impact of a Hypnotically-Based Intervention on Pain and Fear in Women Undergoing Labor. Int J Clin Exp Hypn 2017; 65:64-85. [PMID: 27935457 DOI: 10.1080/00207144.2017.1246876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the effects of a hypnotically-based intervention for pain and fear in women undergoing labor who are about to receive an epidural catheter. A group of 155 women received interventions that included either (a) patient rocking, gentle touching, and hypnotic communication or (b) patient rocking, gentle touching, and standard communication. The authors found that the hypnotic communication intervention was more effective than the standard communication intervention for reducing both pain intensity and fear. The results support the use of hypnotic communication just before and during epidural placement for women who are in labor and also indicate that additional research to evaluate the benefits and mechanism of this treatment is warranted.
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Affiliation(s)
| | - Bryan Langholz
- b University of Southern California , Los Angeles , California , USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sébastien Bloc
- h Hôpital privé Claude Galien , Quincy-sous-Sénart , France
| | - Mark P Jensen
- i University of Washington Seattle, Seattle , Washington , USA
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Trumble J, Lee J, Slater PM, Sellors J, Cyna AM. Consent for Labour Epidural Analgesia: An Observational Study in a Single Institution. Anaesth Intensive Care 2015; 43:323-7. [DOI: 10.1177/0310057x1504300307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a wide range of practice amongst obstetric anaesthetists when obtaining consent for women requesting labour epidural analgesia. This is the first prospective observational study recording the number and types of risks mentioned and whether the risk was quantified. Statements of benefits and alternatives to the procedure were also noted. Fourteen anaesthetists, each consulting a single patient, were recorded during the process of obtaining consent and inserting the epidural. The most commonly mentioned risks (median 7) were headache/dural puncture, failure/difficulty with insertion, nerve damage, bleeding/haematoma and infection/epidural abscess. There was no difference between consultants and trainees, although consultants showed greater variance. It was uncommon for anaesthetists to state a benefit (21%) or mention an alternative option (21%), but there was usually a quantitative statement of risk (71%). Data showed a deviation from the Australian and New Zealand College of Anaesthetists guidelines and these findings may encourage anaesthetists to reflect on their own practice and guide future research.
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Affiliation(s)
- J. Trumble
- Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, South Australia
| | - J. Lee
- Anaesthetic Department, Flinders Medical Centre, Adelaide, South Australia
| | - P. M. Slater
- Northampton General Hospital, Cliftonville, United Kingdom
| | - J. Sellors
- Leeds General Infirmary, Leeds, United Kingdom
| | - A. M. Cyna
- Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia
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Abstract
BACKGROUND Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery. METHODS A convenience sample of anesthetists had their pre-anesthesia consultations voice recorded, prior to elective surgery, during a 4-month period at the largest tertiary referral centre for pediatric care in South Australia. A data collection form was used to note baseline demographic data, and voice recording transcripts were independently documented by two researchers and subsequently compared for accuracy regarding the number and nature of risks discussed. RESULTS Of the 96 voice recordings, 91 (92%) were suitable for the analysis. The five most commonly discussed risks were as follows: nausea and vomiting (36%); sore throat (35%); allergy (29%); hypoxia (25%); and emergence delirium (19%). Twenty-seven pre-anesthetic consultations (30%) were found to have had no discussion of anesthetic risk at all while a further 23 consultations (26%) incorporated general statements inferring that anesthesia carried risks, but with no elaboration about their nature, ramifications or incidence. The median number of risks (IQR) specifically mentioned per consultation was higher, 3 (1) vs 1 (1), P < 0.05, when the consultation was performed by a trainee rather than a consultant anesthetist and when the patient had previous anesthesia experience odds ratio 0.34, 95% CI [0.13, 0.87], P = 0.025. CONCLUSIONS The pediatric anesthesia risk discussion is very variable. Trainees tend to discuss more specific risks than consultants and a patient's previous experience of anesthesia was associated with a more limited discussion of anesthesia risk.
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Affiliation(s)
- Zoe Lagana
- Department of Paediatric Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia
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