The Hand Surgeon Consultation Improves Patient Knowledge in a Hand Surgery Mission to Honduras

Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion

Background

One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process.

Objective

The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice.

Methods

Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts.

Results

Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care.

Conclusion

This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06456-7.

Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge, Anxiety, and Informed Consent

BACKGROUND

Patient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty.

METHODS

A team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05.

RESULTS

Seventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047).

CONCLUSION

On this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.

Barriers to Obtaining Informed Consent on Shortterm Surgical Missions

Short-term surgical missions (STSMs) enable visiting surgeons to help address inequalities in the provision of surgical care in resource-limited settings. One criticism of STSMs is a failure to obtain informed consent from patients before major surgical interventions. We aim to use collective evidence to establish the barriers to obtaining informed consent on STSMs and in resource-limited settings and suggest practical solutions to overcome them.

METHODS

A systematic review was performed using PubMed and Web of Science databases and following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. In addition to the data synthesized from the systematic review, we also include pertinent data from a recent long-term follow-up study in Ethiopia.

RESULTS

Of the 72 records screened, 11 studies were included in our review. The most common barrier to obtaining informed consent was a paternalistic approach to medicine and patient education. Other common barriers were a lack of ethics education among surgeons in low-income and middle-income countries, cultural beliefs toward healthcare, and language barriers between the surgeons and patients. Our experience of a decade of reconstructive surgery missions in Ethiopia corroborates this. In a long-term follow-up study of our head-and-neck patients, informed consent was obtained for 85% (n = 68) of patients over a 14-year period.

CONCLUSIONS

This study highlights the main barriers to obtaining informed consent on STSMs and in the resource-limited setting. We propose a checklist that incorporates practical solutions to the most common barriers surgeons will experience, aimed to improve the process of informed consent on STSMs.

Outcomes of 1,327 patients operated on through twelve multispecialty surgical volunteerism missions: A retrospective cohort study

BACKGROUND

Surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide. The aim of this study was to evaluate the outcomes of 12 surgical missions between 2006 and 2018 from the mission entitled "Operation Giving Back Bohol" Tagbilaran, Philippines and discuss the lessons learned during these missions in particular seven challenges that every volunteer surgeon should be familiar with.

METHODS

This was a retrospective descriptive study of prospectively collected data on all patients treated during one SVM. The data collected included gender, age, diagnosis, types of surgeries performed, and perioperative adverse events.

RESULTS

During the study period 1327 operations were performed (842 females (63.4%) and 485 males (36.6%); (male-to-female ratio 0.59); mean age 37 ± 18 years. The majority of operations were for thyroid disease (31.6%), followed by hernia (17.3%), hysterectomies/salpingo-oophorectomies (12.2%), soft tissue tumors (9.9%), cleft lip/palate repairs (7.2%), breast (6.4%), gallbladder disease (4.7%), cataract (2.9%), parotid masses (1.4%) and others (6.4%). For each mission, there were an average 5.5 days of operating, performing a median of 105.5 (80-148) cases per mission. There were 27 complications (2%), of which, 22 were postoperative bleeding and two temporary tracheostomies. The mortality rate was 0.15% (2/1327). In one patient, the family withdrew care following compassionate last ditch effort thyroidectomy for advanced cancer and one patient died as a result of intracranial bleeding from a brain tumor, which was unrecognized before mastectomy.

CONCLUSIONS

Surgical volunteerism missions are safe and valuable in lessening the burden of surgical disease globally when performed in an organized fashion and with continuity of care. However, there is need for standardization of surgical care provided during SVMs and creation of a world-wide database of all SVMs, and each surgeon and others who participate in these mission should be familiar with critical elements and challenges for the successful mission.