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Kiernan A, Fahey B, Guraya SS, Boland F, Moneley D, Doyle F, Harkin DW. Digital technology in informed consent for surgery: systematic review. BJS Open 2023; 7:7000436. [PMID: 36694387 PMCID: PMC9874030 DOI: 10.1093/bjsopen/zrac159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/03/2022] [Accepted: 10/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Informed consent is an ethical and legal requirement in healthcare and supports patient autonomy to make informed choices about their own care. This review explores the impact of digital technology for informed consent in surgery. METHODS A systematic search of EBSCOhost (MEDLINE/CINAHL), Embase, Cochrane Central Register of Controlled Trials and Web of Science was performed in November 2021. All RCTs comparing outcomes of both digital and non-digital (standard) consent in surgery were included. Each included study underwent an evaluation of methodological quality using the Cochrane risk of bias (2.0) tool. Outcomes assessed included comprehension, level of satisfaction and anxiety, and feasibility of digital interventions in practice. RESULTS A total of 40 studies, across 13 countries and 15 surgical specialties were included in this analysis. Digital consent interventions used active patient participation and passive patient participation in 15 and 25 studies respectively. Digital consent had a positive effect on early comprehension in 21 of 30 (70 per cent) studies and delayed comprehension in 9 of 20 (45 per cent) studies. Only 16 of 38 (42 per cent) studies assessed all four elements of informed consent: general information, risks, benefits, and alternatives. Most studies showed no difference in satisfaction or anxiety. A minority of studies reported on feasibility of digital technology in practice. CONCLUSION Digital technologies in informed consent for surgery were found to have a positive effect on early comprehension, without any negative effect on satisfaction or anxiety. It is recommended that future studies explore the feasibility of these applications for vulnerable patient groups and busy surgical practice.
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Affiliation(s)
- Aoife Kiernan
- Correspondence to: Aoife Kiernan, RCSI Main Building, 123 St Stephen’s Green, Dublin 2, Ireland (e-mail: )
| | - Brian Fahey
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shaista S Guraya
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland—Bahrain, Busaiteen, Bahrain
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Denis W Harkin
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hanalis-Miller T, Nudelman G, Ben-Eliyahu S, Jacoby R. The Effect of Pre-operative Psychological Interventions on Psychological, Physiological, and Immunological Indices in Oncology Patients: A Scoping Review. Front Psychol 2022; 13:839065. [PMID: 35572335 PMCID: PMC9094613 DOI: 10.3389/fpsyg.2022.839065] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The stressful pre-operative period exerts a profound impact on psychological, physiological and immunological outcomes. Oncological surgeries, in particular, elicit significantly higher stress responses than most other surgeries. Managing these responses through psychological interventions may improve long-term outcomes. The purpose of the current research was to review studies that have explored pre-operative psychological interventions in cancer patients in order to map the types of current interventions and provide an initial assessment of whether these interventions improved psychological, physiological, and/or immunological indices as well as long-term cancer outcomes. Methods A systematic literature search for studies that included pre-operative psychological interventions in oncology patients was conducted, using the databases PubMed and Web of Science. Inclusion criteria included studies pertaining to oncological surgery in adults, study designs that included a clearly defined pre-operative psychological intervention and control group. Results We found 44 studies, each using one of the following interventions: psychoeducation, cognitive interventions, relaxation techniques, integrated approaches. All the studies reported improved immediate post-operative psychological, physiological, and/or immunological outcomes. Only a few studies addressed long-term cancer outcomes, and only one reported improved survival. Conclusions Research on pre-operative interventions with cancer patients is missing systematic methods. Studies provide varying results, which makes it difficult to compare them and reach reliable conclusions. There is considerable heterogeneity in the literature regarding the specific intervention used, the timing of intervention, the characteristics of the patients studied and the outcome measures. In order to improve research in this field, including the measurement of long-term outcomes, we suggest some steps that should be taken in further research.
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Affiliation(s)
| | - Gabriel Nudelman
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
| | - Shamgar Ben-Eliyahu
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Rebecca Jacoby
- Stress, Hope and Cope Laboratory, School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
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The Effect of Photographic Visual Aids in Preoperative Patient Counseling in Oculoplastic Surgery. Ophthalmic Plast Reconstr Surg 2021; 37:S70-S75. [PMID: 32976331 DOI: 10.1097/iop.0000000000001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the effect of visual supplementation and its mode of delivery in preoperative counseling of patients undergoing oculoplastic surgery. METHODS A prospective randomized controlled trial of consecutive patients undergoing oculoplastic eyebrow and eyelid surgery was conducted. Patients were randomized to an "oral only" group receiving routine preoperative oral counseling or an "oral and visual" group receiving identical counseling visually supplemented with photographs demonstrating common postoperative physical findings. Patients in the "oral and visual" group were further randomized to receive education from the medical team in person versus prerecorded video. Patient emotions and expectations regarding postoperative healing were assessed preoperatively and at 1 week and 2 months postoperatively. RESULTS 103 patients were included: 32 received in-person oral education, 33 received in-person oral education with photographs, and 38 received education with photographs via video. There were no significant differences in demographics or preoperative patient fear, anxiety, or preparedness. The "oral and visual" group expected more severe postsurgical discomfort and physical findings at postoperative day 1 and week 1. There were no significant differences between groups in surgery signup, cancellation, or triage call rates; patient expectations of postoperative months 2 and 4; or in anxiety, preparedness, or satisfaction. CONCLUSIONS Visual supplementation in preoperative counseling increases patient expectations of postoperative physical findings without escalating fear or anxiety, and has no significant impact on patient emotions, triage call rates, and satisfaction throughout their surgical experience. Preoperative education via video is perceived by patients to be equivalent to counseling in person by the surgeon.
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Kynoch K, Ramis MA, Crowe L, Cabilan CJ, McArdle A. Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review. ACTA ACUST UNITED AC 2020; 17:1130-1153. [PMID: 31192898 DOI: 10.11124/jbisrir-2017-003914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of this scoping review was to explore the information needs and information seeking behaviors of patients and families from healthcare providers in acute healthcare settings in existing literature. INTRODUCTION A well-informed family can be crucial to a patient's capacity to cope with their diagnosis and hospital care during acute or chronic illness. Information is therefore critical to both the patient's and family's understanding of the illness and healthcare process. Providing appropriate and timely information can empower patients and families with knowledge and alleviate the anxiety and stress associated with a hospital admission. However, acutely ill patients and families in different acute care settings have considerable and differing information needs. INCLUSION CRITERIA This scoping review included studies undertaken in acute healthcare facilities where patients were over 18 years of age and family members were of any sex, culture and ethnicity. Family was defined as anyone connected to the patient by blood, marriage or other significant relationship. Healthcare provider perspectives of family and patient information needs were excluded. Concepts related to type of information, timing of information, preferences for who delivers the information and method of information delivery. Qualitative and quantitative study designs published from 2010 to 2017 in English were included. METHODS Multiple databases were searched to find published and unpublished studies. A three-step search strategy was utilized. A charting table was developed for the data extraction process to record data relating to the review objectives. Specific data extracted included details on research design, geographical location, year of publication, characteristics of study population, research aims and outcomes as well as key findings related to patient and family information needs. RESULTS The scoping review included 109 studies from across 34 countries. Of these studies, 68 used quantitative research designs, 29 were qualitative in nature and 12 included studies reported using mixed methods. One study used an action research methodology. Nine studies were specific to family information needs. A majority of studies were conducted in the cancer care context, with other acute settings comprising intensive care units, surgical settings and individual medical or surgical units/wards within and across the hospital. While most of the included studies addressed the type of content patients and/or families prefer, a few studies explored the timing of information provision. CONCLUSIONS The international literature on information needs of patient and families comprises multiple published studies on differing aspects of the topic and situated within various acute care contexts. Despite the broad nature of the research, studies suggest that preferences regarding information content, timing of information delivery and choices regarding who delivers information vary across contexts and according to the patient/family member. The complexity behind this variation and strategies to address tailoring information delivery requires further in-depth research.
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Affiliation(s)
- Kate Kynoch
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | - Mary-Anne Ramis
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | - Linda Crowe
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | | | - Annie McArdle
- Parent Education and Support Services, Mater Mothers' Hospital, South Brisbane, Australia
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Glaser J, Nouri S, Fernandez A, Sudore RL, Schillinger D, Klein-Fedyshin M, Schenker Y. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review. Med Decis Making 2020; 40:119-143. [PMID: 31948345 DOI: 10.1177/0272989x19896348] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008-2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients' understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants' education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants' race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.
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Affiliation(s)
- Johanna Glaser
- School of Medicine, University of California, San Francisco, CA, USA
| | - Sarah Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Alicia Fernandez
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | | | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Gezer D, Arslan S. The Effect of Education on the Anxiety Level of Patients Before Thyroidectomy. J Perianesth Nurs 2018; 34:265-271. [PMID: 30245033 DOI: 10.1016/j.jopan.2018.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/25/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The present study aims to evaluate the effect of preoperative education on the level of anxiety provided to patients scheduled for thyroidectomy using education brochures on the level of anxiety. DESIGN The study design was quasi-experimental. METHODS The study data were collected using the Patient Information Form and the Turkish version of the Anxiety Specific to Surgery Questionnaire (ASSQ). Study group patients were informed by brochure before 24 hours. Control group patients were informed verbally during routine preoperative preparation or 1 day before surgery. Test and control group patients were resubjected to the ASSQ before being transported from their unit beds to the operating room. FINDINGS There was no significant difference in the mean scores of the pretest and final test ASSQ scores for the test and control groups (P > .05). CONCLUSIONS Our study results showed that education provided to the patients scheduled for thyroid surgery using written materials did not affect anxiety.
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Smith PR, Cope D, Sherner TL, Walker DK. Update on research-based interventions for anxiety in patients with cancer. Clin J Oncol Nurs 2015; 18 Suppl:5-16. [PMID: 25427605 DOI: 10.1188/14.cjon.s3.5-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety may begin at the moment a person is diagnosed with cancer and may fluctuate throughout the cancer trajectory as physical illness improves or declines. The purpose of this article is to present current evidence for nurses to implement interventions to reduce anxiety in patients who have cancer. The PubMed and CINAHL® databases were searched to identify relevant citations addressing interventions that treat or prevent anxiety symptoms in patients with cancer. Based on available evidence, the interventions addressed herein are categorized according to the Putting Evidence Into Practice (PEP®) rating schema. Interventions include pharmacologic and nonpharmacologic approaches to care, and meet criteria for three PEP categories: likely to be effective, effectiveness not established (the largest category of results), or effectiveness unlikely.
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Affiliation(s)
- Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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Waller A, Forshaw K, Bryant J, Carey M, Boyes A, Sanson-Fisher R. Preparatory education for cancer patients undergoing surgery: A systematic review of volume and quality of research output over time. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)00229-3. [PMID: 26072423 DOI: 10.1016/j.pec.2015.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/28/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the volume and scope of research output examining preparation of patients for people undergoing cancer-related surgical treatment, and the impact of pre-operative education on patient outcomes and health care utilisation. METHODS Medline, EMBASE, PsychINFO databases were systematically searched. Eligible papers were coded as data-based or non-data-based. Data-based papers were further classified as descriptive, measurement or intervention studies. Methodological quality and effectiveness of intervention studies were assessed using Cochrane Effective Practice and Organisation of Care (EPOC) criteria. RESULTS We identified 121 eligible papers. The number of publications significantly increased over time. Most were data-based (n=99) and descriptive (n=83). Fourteen intervention studies met EPOC design criteria. Face-to-face interventions reported benefits for anxiety (5/7), satisfaction (1/1), knowledge (3/3) and health care costs (1/1). Audio-visual and multi-media interventions improved satisfaction (1/1) and knowledge (2/3), but not anxiety (0/3). Written interventions were mixed. CONCLUSION Descriptive studies dominate the literature examining preoperative education in oncology populations, with few rigorous intervention studies. Pre-operative education can improve satisfaction, knowledge and reduce anxiety. PRACTICE IMPLICATIONS Further work should be directed at multi-modal interventions, and those that include the caregiver, given their role in assisting patients to prepare and recover from surgery.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Kristy Forshaw
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia
| | - Jamie Bryant
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia
| | - Mariko Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia
| | - Allison Boyes
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia
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Fulcher CD, Kim HJ, Smith PR, Sherner TL. Putting evidence into practice: evidence-based interventions for depression. Clin J Oncol Nurs 2014; 18 Suppl:26-37. [PMID: 25427607 DOI: 10.1188/14.cjon.s3.26-37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society's Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article.
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Affiliation(s)
| | - Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul
| | - Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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Aviado-Langer J. Measuring preoperative anxiety in patients with breast cancer using the visual analog scale. Clin J Oncol Nurs 2014; 18:489-91. [PMID: 25253102 DOI: 10.1188/14.cjon.489-491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preoperative anxiety is a prevalent concern with deleterious effects in patient recovery and is not routinely assessed in the preoperative screening process. When it is assessed, it may prompt an increase in the use of anesthetic agents, heightened postoperative pain, and prolonged hospitalization. Preoperative women with breast cancer face anxiety as it relates to anesthesia, surgery, and recovery. The preoperative anxiety visual analog scale may identify and quantify anxiety in this population, provide advocacy and support, and improve the preoperative screening process.
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