Patient engagement study to identify and improve surgical experience.

BACKGROUND: Patient engagement is the establishment of active partnerships between patients, families, and health professionals to improve healthcare delivery. The objective of this project was to conduct a series of patient engagement workshops to identify areas to improve the surgical experience and develop strategies to address areas identified as high priority. METHODS: Faculty surgeons and patients were invited to participate in three in-person meetings. Evaluation included identifying and developing strategies for three priority areas to improve the surgical experience and level of engagement achieved at each meeting. RESULTS: Sixteen faculty surgeons and 32 patients participated. Some 63 themes to improve the surgical experience were identified; the three highest-priority themes were physician communication, discharge process, and expectations at home after discharge. Individual improvement strategies for these three prioritized themes (12, 36 and 6 respectively) were used to develop a formal strategic plan, and included a physician communication survey, discharge process worksheet and video, and guideline regarding what to expect at home after discharge. Overall, the level of engagement achieved was considered high by over 85 per cent of the participants. CONCLUSION: A high level of patient engagement was achieved. Priorities were identified with patients and surgeons to improve surgical experience, and strategies were developed to address these areas.

Pre-operative Anxiety in Pediatric Surgery Patients: Multiple Case Study Analysis with Literature Review.

Pre-operative anxiety affects millions of pediatric surgery patients each year and can have both short and long-term adverse effects in the post-operative period. As a result, it is particularly important for healthcare providers and others involved in the child's care, such as the parents, to be aware of interventions that can be used to reduce the onset of pre-operative anxiety and, thus, the likelihood of negative post-operative changes. The purpose of this paper is to familiarize the reader with the issue of pre-operative anxiety through a review of the literature and analysis of case studies. First, the paper looks at the causes of pre-operative anxiety and its effect on the development of maladaptive behavioral, emotional, and physiological changes. It then discusses the ways pre-operative anxiety can be measured and current methods for reducing the post-operative adverse outcomes associated with it. After doing so, it proposes the need for additional research and the use of precision medicine by physicians.

The Effect of Perioperative Music on the Stress Response to Surgery: A Meta-analysis.

BACKGROUND: Current perioperative patient care aims to maintain homeostasis by attenuation of the stress response to surgery, as a more vigorous stress response can have detrimental effects on postoperative recovery. This systematic review and meta-analysis aims to assess the effect of perioperative music on the physiological stress response to surgery. METHODS: The Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar databases were searched from inception date until February 5, 2019, using a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines for randomized controlled trials investigating the effect of music before, during, and/or after surgery in adult surgical patients on the stress response to surgery. Meta-analysis was performed using a random effects model and pooled standardized mean differences were calculated with 95% confidence intervals. This study was registered in the PROSPERO database (CRD42018097060). RESULTS: The literature search identified 1076 articles. Eighteen studies (1301 patients) were included in the systematic review, of which eight were included in the meta-analysis. Perioperative music attenuated the neuroendocrine cortisol stress response to surgery (pooled standardized mean difference -0.30, [95% confidence interval -0.53 to -0.07], P = 0.01, I2 = 0). CONCLUSIONS: Perioperative music can attenuate the neuroendocrine stress response to surgery.

Psychological factors, prehabilitation and surgical outcomes: evidence and future directions.

The pre-operative optimisation of comorbidities is increasingly recognised as an important element of the pre-operative pathway. These efforts have primarily focused on physical comorbidities such as anaemia and the optimisation of exercise and nutrition. However, there is a growing recognition of the importance of psychological morbidity. Increasingly, evidence suggests that psychological factors have an impact on surgical outcomes in both the short and long term. Pre-operative anxiety, depression and low self-efficacy are consistently associated with worse physiological surgical outcomes and postoperative quality of life. This has led to the emergence of psychological prehabilitation and the trimodal approach to prehabilitation, incorporating psychological intervention as well as exercise and nutritional optimisation. However, there is currently insufficient evidence to be sure that pre-operative psychological interventions are of benefit, or which interventions are most effective, because their impact has been mixed. There is an urgent need for high quality, contemporaneous prospective trials with baseline psychological evaluation, well-described interventions and agreement on the most appropriate psychological, quality of life and physiological outcomes measures.

The readability of psychosocial wellness patient resources: improving surgical outcomes.

BACKGROUND: Patient education is increasingly accessed with online resources and is essential for patient satisfaction and clinical outcomes. The average American adult reads at a seventh grade level, and the National Institute of Health (NIH) and the American Medical Association (AMA) recommend that information be written at a sixth-grade reading level. Health literacy plays an important role in the disease course and outcomes of all patients, including those with depression and likely other psychiatric disorders, although this is an area in need of further study. The purpose of this study was to collect and analyze written, online mental health resources on the Veterans Health Administration (VA) website, and other websites, using readability assessment instruments. METHODS: An internet search was performed to identify written patient education information regarding mental health from the VA (the VA Mental Health Website) and top-rated psychiatric hospitals. Seven mental health topics were included in the analysis: generalized anxiety disorder, bipolar, major depressive disorder, posttraumatic stress disorder, schizophrenia, substance abuse, and suicide. Readability analyses were performed using the Gunning Fog Index, the Flesch-Kincaid Grade Level, the Coleman-Liau Index, the SMOG Readability Formula, and the Automated Readability Index. These scores were then combined into a Readability Consensus score. A two-tailed t-test was used to compare the mean values, and statistical significance was set at P < 0.05. RESULTS: Twelve of the best hospitals for psychiatry 2016-2017 were identified. Nine had educational material. Six of the nine cited the same resource, The StayWell Company, LLC (StayWell Company, LLC; Yardley, PA), for at least one of the mental health topics analyzed. The VA mental health website (http://www.mentalhealth.va.gov) had a significantly higher readability consensus than six of the top psychiatric hospitals (P < 0.05, P = 0.0067, P = 0.019, P = 0.041, P = 0.0093, P = 0.0054, and P = 0.0093). The overall average readability consensus for mental health information on all websites analyzed was 9.52. CONCLUSIONS: Online resources for mental health disorders are more complex than recommended by the NIH and AMA. Efforts to improve readability of mental health and psychosocial wellness resources could benefit patient understanding and outcomes, especially in patients with lower literacy. Surgical outcomes are correlated with patient mental health and psychosocial wellness and thus can be improved with more appropriate levels of readability of psychosocial wellness resources.

Effects of Art on Surgical Patients: A Systematic Review and Meta-analysis.

OBJECTIVES: The aim of the study was to assess the effect of art including ambient features such as music, interior design including visual art, and architectural features on health outcomes in surgical patients. BACKGROUND: Healing environments can have a positive influence on many patients, but data focusing on art in surgical patients remain scarce. METHODS: We conducted a systematic search following the PRISMA guidelines from January 2000 to October 2014 on art in surgical patients. For music interventions, we pooled controlled studies measuring health outcomes (eg, pain, anxiety, blood pressure, and heart rate) in a meta-analysis. For other art forms (ambient and architectural features and interior design), we did a narrative review, also including nonsurgical patients, and looked for examples covering 3 countries. RESULTS: Our search identified 1101 hits with 48 studies focusing on art in surgical patients: 47 studies on musical intervention and 1 on sunlight. The meta-analysis of these studies disclosed significant effects for music on pain after surgery, anxiety, systolic blood pressure, and heart rate, when compared with control groups without music. Effects of music were larger with self-selected music, and lower in surgical interventions performed under general anesthesia. Interior design features such as nature images and more spacious rooms, and architectural features providing more sunlight had positive effects on anxiety and postoperative pain. CONCLUSIONS: Self-selected music for surgical patients is an effective and low-cost intervention to enhance well being and possibly faster recovery. Although potentially very important, the impact of environmental features and spacious architecture with wide access to sunlight remains poorly explored in surgery. Further experimental research is needed to better assess the magnitude of the impact and cost effectiveness.

Developing biographies: the experiences of children, young people and their parents of living with a long-term condition.

This article reports on data from a qualitative interview study that sought to understand the experiences, choices and actions of children and young people undergoing surgery for a long-term condition and that of their parents. Using the concept of biography the article examines how the biographies of children, young people and their parents can be influenced by surgery and the ongoing management of a long-term continence condition. This article challenges previous work that characterises the presence of a condition from birth as a continuous and normal part of the illness experiences of these patients. Although this may be the case in some instances, children, young people and their parents can experience diverse and changing experiences associated with ongoing condition management as well as surgery. Biographical continuity, enrichment and disruption are all relevant concepts for such patients living with a long-term continence condition. These can be influenced by their previous experiences of their condition, their expectations, and dynamics with parents, including changes associated with development and the increasing independence of young people.

What would I want for my surgery?

If you were to have an operation tomorrow, would you want your surgical team members to feel comfortable speaking up, to defy hierarchy, to interact with each other just as well as they perform technical aspects of the procedure? Would you want to feel like part of the team? Your answers to these admittedly leading questions are based on the culture of the surgical team and the interdependence of team members and are at the heart of a current debate around the surgical checklist's effectiveness. In British Columbia (BC), many individuals responded to the paper by Urbach et al. (2014) that described the minimal impact on patient mortality after implementation of the surgical safety checklist in Ontario. They wrote to the Surgical Quality Action Network (SQAN) to express their perspectives, and interestingly, some refuted and others supported the conclusions. Given the strong reaction this study created in the surgical community, a number of key stakeholders have prepared a response in order to provide another perspective to the article and emphasize the checklist's value for improving the culture of surgical teams.

Health literacy friendly organizations - A scoping review about promoting health literacy in a surgical setting.

OBJECTIVE: This review aims to describe interventions that promote health literacy in a surgical setting and identify knowledge gaps for future research. METHODS: A scoping review with a systematic search was performed in Medline, CINAHL, Scopus, and Web of Science between January 1, 2012, and January 23, 2024. All screening was conducted using the Covidence software. In total, the search yielded 6 281 articles. RESULTS: Eighteen articles were included in the results. Studies were heterogeneous regarding the type of health literacy measured, type of surgery, and type of intervention. Most interventions were educational to improve knowledge, decision making or health literacy through digital media, group sessions or consent forms. Most interventions had a positive impact on health literacy. CONCLUSIONS: Patients with limited health literacy may benefit from a variety of interventions. However, research in this area is sparse. Further research is needed into interventions that may be beneficial for patients. PRACTICE IMPLICATIONS: Measure, evaluate and implement health literacy-friendly options to ensure people can make safe and sound decisions for their care. Researchers need to consider the type of health literacy investigated and the type of instrument used in the research.

Evaluation of "Steps to Surgical Success" (STEPS): a holistic perioperative medicine program to manage pain and anxiety related to surgery.

This empirical study found that a holistic perioperative program significantly reduced patient pain and anxiety about surgery. Modalities included guided imagery, eye pillow, aromatherapy, and a written personal healing plan. Nurses are in a prime position to deliver these interventions, given their frequent direct contact with patients.

Analysing a family-centred preoperative intervention programme: a dismantling approach.

BACKGROUND: The goal of this project was to identify key effective components of ADVANCE, a family-centred preoperative intervention programme, through the use of a dismantling approach. ADVANCE was previously demonstrated to be more effective than parental presence and just as effective as midazolam in reducing children's preoperative anxiety. The total programme, however, may be difficult to implement in hospitals across the country. METHODS: Subjects in this follow-up dismantling report were 96 children aged 2-10 who were part of the original study and who underwent anaesthesia and surgery. Baseline characteristics, parental adherence to the components of ADVANCE, and child and parent anxiety were assessed. RESULTS: We found that greater parental adherence to the ADVANCE intervention was associated with lower child anxiety before surgery. The two components of ADVANCE that emerged as having a significant impact on children's anxiety were practising with the anaesthesia mask at home and parental planning and use of distraction in the preoperative holding area. In fact, not only did children experience significantly less preoperative anxiety when their parents were adherent to mask practise and use of distraction, their anxiety tended to remain stable and relatively low throughout the preoperative period. CONCLUSIONS: Shaping and exposure (i.e. practise with the anaesthesia mask) and parental use of distraction in the surgical setting are two beneficial components that could be included in preoperative preparation programmes that will be designed in the future.

Communication of bad news in relation with surgery or anesthesia: An interdisciplinary simulation training program.

INTRODUCTION: Disclosure of damage related to care is a difficult area of communication due to the physician's feeling of guilt or the fear of liability. The aim of this study was to develop, and to evaluate the impact of an inter-disciplinary simulation program on communication of damage related to care. METHODS: Residents in gynecology/obstetrics and anesthesiology participated in role-playing scenarios of communication of damage related to care. We assessed verbal, non-verbal communication skills and inter-disciplinary relations with a modified SPIKES protocol and with a video analysis with predefined indicators. We evaluated long-term impact of the training at 3-6 months with combining self-assessment and a video analysis on retained knowledge. RESULTS: We included 80 residents in 15 sessions of simulation. Satisfaction regarding the simulation training was high (9.1/10 [8.9-9.3]). The part of the SPIKES protocol "setting up the interview" was the more difficult to apply. Empathic attitude was adopted 80 % of the time in the two scenarios with a life-threatening complication but was less common in the anesthetic one (broken tooth). The residents found interdisciplinary disclosure helpful due to support from the other resident. Immediately after the session, residents reported an important improvement in communication skills and that the session would significantly change their practice. At 3-6 months, reports were still largely positive but less than on immediate evaluation. CONCLUSION: Residents did not master the most important communication skills. The interdisciplinary method to breaking bad news was felt useful.

Using a collaborative child life approach for continuous surgical preparation.

Child life specialists in surgical and perioperative programs use a systematic approach to provide continuous preparation for pediatric surgical patients. Within the context of family-centered care, all staff members share in the ongoing responsibility of minimizing stress and maximizing effective coping for children and their parents or caregivers. Multidisciplinary collaboration increases positive outcomes for pediatric patients and their families. Detailed descriptions of the procedures used at Children's Hospital Boston and a case study are discussed to exemplify the coping benefits of using a collaborative child life approach to provide continuous preparation for surgical patients.

[Effect of the music-therapy under spinal anesthesia].

BACKGROUND: Since no pre-medication has been widely accepted especially in spinal anesthesia, anesthesiologists should manage the control of patient's anxiety during surgery. Instead of sedatives, we have been using music-therapy during spinal anesthesia. Bispectral index monitoring (BIS) is used as one of the sedation indices in spinal anesthesia. The aim of this study was to assess the music-therapy on reducing anxiety of patients under spinal anesthesia using BIS and interview type psychology test, State Trait Anxiety Inventory (STAI). METHODS: Fifty-eight ASA physical status I-II patients scheduled for spinal anesthesia, were randomly allocated into M group (music group, n=29) or C group (control, n=29). BIS, EMG, and SQI of both groups were obtained continuously with computer system. Patients in M group listened to music by head phone and those in C group were left free under ordinary operating theater environment. Trait Anxiety Inventory (STAI-TA) score was obtained preoperatively for property-based anxiety and the State Anxiety Inventory (STAI-SA) score was obtained postoperatively for condition-based anxiety. Time averaged BIS scores (pre-surgery, during-surgery and post-surgery period)were obtained during operation. RESULTS: Time averaged BIS values of M and C group in pre-surgery period, during-surgery period, and post-surgery period were 95.3+/-0.4 vs 95.8+/-0.4 (NS), 87.6+/-7.5 vs 95.1+/-2.8 (P<0.01) and 96.0+/-0.4 vs. 96.2+/-0.4 (NS), respectively. Post-surgery STAI-SA was 29.7+/-7.2 in M group vs 38.8+/-10.3 in C group (P<0.01) while pre-surgery STAI-SA scores of both groups were not different. CONCLUSIONS: Music-therapy reduced BIS value and was effective to reduce patient's anxiety during spinal anesthesia.

Effects of psychological problems on surgical outcomes.

Surgeons are becoming aware that surgical outcomes are not only based on technical skills. The impact of psychological problems on outcomes must be studied from both the patient's and the health care provider's viewpoint. Psychological problems may affect up to 20% of the population, with almost half of them non-treated. Surgeons have to deal with a significant number of patients with psychological problems, which affect surgical outcomes changing how symptoms, results and side effects are interpreted. Surgeons also face psychological problems at a significant rate. Although there are no studies on the effect of chronic psychological problems of the surgeon on outcomes, in simulated scenarios, acute stress usually leads to worse performance. Some initiatives can be implemented to improve outcomes based on the effect of psychological problems.

The Effect of Mirroring Display of Virtual Reality Tour of the Operating Theatre on Preoperative Anxiety: A Randomized Controlled Trial.

A virtual reality (VR) tour of the operating theatre could reduce preoperative anxiety by providing a realistic experience for children. This randomized clinical trial was designed to determine whether parental co-experience of preoperative VR tour through a mirroring display could further reduce preoperative anxiety. Eighty children scheduled for elective surgery under general anesthesia were randomly allocated into either the control or mirroring group. Children in the control group watched a 4-min immersive VR video showing the operating theatre and explaining the preoperative process, via a head mounted display. In the mirroring group, parents of children watched the same video through mirroring display concurrently while their child experienced the immersive VR tour. Preoperative anxiety and satisfaction score were measured. Eighty children completed the final analysis (control group = 40 and mirroring group = 40). Preoperative anxiety of children (p = 0.025) and parents (p = 0.009) were lower in the mirroring group compared with the control group. Parents' satisfaction in the mirroring group was significantly higher than those in the control group (p = 0.008). Parental co-experience of the VR tour with children through mirroring the display was effective in reducing preoperative anxiety in both children and parents.