Information for surgical patients: implications of the World Wide Web

Patients want to be seen: The top 3 information needs of patients with inguinal hernia

Background

Good patient information has shown to improve surgical outcomes. In this study we explore what kind of pre-surgical information patients need and if the provision of a 360˚ video of a surgical procedure can be of added value to the information provided by the hospital.

Methods

An explorative qualitative study using semi-structured interviews on information needs was conducted among 17 inguinal hernia patients to gain more insight in the patients’ present surgical information needs. Patients either were planned to receive or already had received a surgical procedure. Questions were asked about the current information provision and, after being shown a 360˚ video of the surgery, whether this would be of added value.

Results

Of the total group of 17 patients (mean age 56, interquartile range 45–64) 16 were male and one was female. Most had no previous experience with virtual reality (14/17), already had undergone a surgical procedure (11/17). Patient information needs were all about “seeing” which can be viewed from three different perspectives [1] being seen as a unique person in the treatment process, [2] being seen as a partner, and [3] seeing is understanding. Patients wanted the contact with the doctor to be more personal, with the possibility to see the anesthetist in person, the surgeon to see their wound in the recovery phase, and to receive personal answers to questions about their specific situation. Patients found the 360-video not fearsome, and believed that visual content could be beneficial as it appeals more to their imagination than written or oral information and increases their understanding. It also provided them with a better understanding of their treatment options, their pre-, peri-, and post-surgical procedures and identification of the cause of post-operative side effects.

Conclusion

To address patients’ information needs, complementary tools or services are needed that increase personal contact as well as tailor it to individual patient’s needs. Even though video-apps are a partial alternative, hospitals should still offer patients the possibility of having face-to-face meetings with physicians as this is highly valued by patients and leads to increased trust in physicians’ performance.

THE WEB: FRIEND OR FOE OF THE HAND SURGEON?

Healthcare information contained on the World Wide Web is not screened or regulated and claims may be unsubstantiated and misleading. The objective of this study was to evaluate the nature and quality of information on the Web in relation to hand surgery. Three search engines were assessed for information on three hand operations: carpal tunnel decompression, Dupuytren's release and trigger finger release. Websites were classified and evaluated for completeness, accuracy, accountability and reference to a reliable source of information. A total of 172 websites were examined. Although 85% contained accurate information, in 65% this information was incomplete. Eighty-seven per cent of websites were accountable for the information presented, but only 24% made references to reliable sources. Until an organised approach to website control is established, it is important for hand surgeons to emphasise to their patients that not everything they read is complete or accurate. Publicising sites known to be of high quality will promote safe browsing of the Web.

Determining patient concerns before joint arthroplasty

Despite the prevalence of studies relating to hip and knee arthroplasties, no Canadian studies exist in the literature regarding patients' perceptions and concerns prior to undergoing these procedures. A 32-question, 5-point Likert scale questionnaire was developed and administered to a Canadian cohort. One hundred fifty-six knee and 85 hip arthroplasty patients returned the survey. Results consistently showed complications arising from surgery, ways to reduce pain after surgery, and ability to walk properly again as the 3 top concerns for patients whether stratified by age, sex, residential status or joint replacement type. Other results discussed include resources used by patients to become better informed about joint arthroplasty, differences in Western Ontario and McMaster Universities Index of Osteoarthritis scores between groups, and significant differences in patient concerns as determined by ridit analyses.

Use of the internet by patients undergoing elective hernia repair or cholecystectomy

INTRODUCTION

Patient-directed information available on the internet is not always regulated; it may be confusing and sometimes just overwhelming. We aimed to establish the proportion of patients undergoing two common surgical procedures, who searched the internet for information about their operations and to assess the usefulness of the information they received.

PATIENTS AND METHODS

A total of 105 consecutive patients undergoing elective abdominal wall hernia repair (n = 54) or laparoscopic cholecystectomy (n = 51) in a single surgical firm were included in the study. Patients were counselled about their operation in pre-operative assessment clinics and standard trust information leaflets were provided without any mention of this study. Patients were then asked to complete a questionnaire on the morning of their operation.

RESULTS

All patients completed the questionnaire. Of the patients, 59% stated that they had access to the internet and 77% of these accessed the internet over 2 h a week. Of the patients with internet access, 31% used it to acquire additional information about their operations and 58% used internet search engines. Of the patients who searched the internet regarding their operations, 26% were confused and/or worried by the information they received.

CONCLUSIONS

A significant proportion of patients undergoing common surgical procedures used the internet and about one-third of them specifically sought information about their operation on the internet. Such information can cause worry and confusion in patients. Our study highlights the need for regulated, comprehensible, patient information on hospital websites to which patients should be directed.

Information and behavioural instruction along the health-care pathway: the perspective of people undergoing hernia repair surgery and the role of formal and informal information sources

BACKGROUND

Provision of information and behavioural instruction has been demonstrated to improve recovery after surgery. However, patients draw on a range of information sources and it is important to establish which sources patients use and how this influences perceptions and behaviour as they progress along the surgical pathway. In this qualitative, exploratory and longitudinal study, the use of information and instruction were explored from the perspective of people undergoing inguinal hernia repair surgery.

METHODS

Seven participants undergoing inguinal hernia repair surgery were interviewed using semi-structured interviews 2 weeks before surgery and 2 weeks and 4 months post-surgery. Nineteen interviews were conducted in total. Topic guides included sources of knowledge, reasons for help-seeking and opting for surgery and factors influencing return to activity. Data were analysed thematically according to Interpretative Phenomenological Analysis.

FINDINGS AND CONCLUSIONS

Participants sought information from a range of sources, focusing on informal information sources before surgery and using information and instruction from health-care professionals post-surgery. This information influenced behaviours including deciding to undergo surgery, use of pain medication and returning to usual activity. Anxiety and help-seeking resulted when unexpected post-surgical events occurred such as extensive bruising. Findings were consistent with psychological and sociological theories. Overall, participants were positive about the information and instruction they received but expressed a desire for more timely information on post-operative adverse events.

The quality of information about kidney transplantation on the World Wide Web

BACKGROUND

Websites on the Internet are used increasingly by patients and those caring for them as a source of medical information. This study investigated the nature and quality of the kidney transplant-related information currently available on the World Wide Web (WWW).

METHODS

Four common search engines were used to explore the Internet using the keywords "kidney transplantation." Each website was assessed on the following categories: source, language, accessibility, presence of kitemarks, and quality/depth of information. Websites were scored independently by four transplant clinicians (two surgeons and two physicians), and a weighted Information Score (IS) was created to assess the overall clinical and educational value of the site.

RESULTS

A total of 200 potential websites were identified of which 94 websites were suitable for scoring. The remaining 106 were repetitions or non-accessible links. The overall median weighted IS for the sites assessed was 21 (IQR 0-61). Median weighted IS of sites originating from Europe and USA were 47 (IQR = 21-61) and 45 (IQR = 15-61) respectively (p = 0.27). Websites belonging to academic institutions scored higher with a median weighted IS of 49 (IQR = 20-61) when compared with kitemarked websites (median 21, IQR = 5-45, p = 0.01). However, there was no statistically significant difference in weighted IS of kitemarked, professional (median 22, IQR = 2-53), commercial (median 20, IQR = 0-45), and individual websites (median 9, IQR 3-12). There was a good agreement between the observers who scored the websites with an intraclass correlation coefficient (ICC) of 0.79 and an associated 95% CI (0.73-0.90) for the four observers on the 94 websites.

CONCLUSION

The educational material currently available on the WWW about kidney transplantation is often of poor quality and more input is required from transplant clinicians. Quality seals in the form of kitemarks may give a false sense of security. The gaps in validity and accuracy of the information available on complex topics such as kidney transplantation should be filled; otherwise poor quality information will continue to be the norm rather than the exception.

Quality analysis of patient information about knee arthroscopy on the World Wide Web

PURPOSE

This study was designed to ascertain the quality of patient information available on the World Wide Web on the topic of knee arthroscopy.

METHODS

For the purpose of quality analysis, we used a pool of 232 search results obtained from 7 different search engines. We used a modified assessment questionnaire to assess the quality of these Web sites. This questionnaire was developed based on similar studies evaluating Web site quality and includes items on illustrations, accessibility, availability, accountability, and content of the Web site. We also compared results obtained with different search engines and tried to establish the best possible search strategy to attain the most relevant, authentic, and adequate information with minimum time consumption. For this purpose, we first compared 100 search results from the single most commonly used search engine (AltaVista) with the pooled sample containing 20 search results from each of the 7 different search engines. The search engines used were metasearch (Copernic and Mamma), general search (Google, AltaVista, and Yahoo), and health topic-related search engines (MedHunt and Healthfinder). The phrase "knee arthroscopy" was used as the search terminology.

RESULTS

Excluding the repetitions, there were 117 Web sites available for quality analysis. These sites were analyzed for accessibility, relevance, authenticity, adequacy, and accountability by use of a specially designed questionnaire. Our analysis showed that most of the sites providing patient information on knee arthroscopy contained outdated information, were inadequate, and were not accountable. Only 16 sites were found to be providing reasonably good patient information and hence can be recommended to patients. Understandably, most of these sites were from nonprofit organizations and educational institutions. Furthermore, our study revealed that using multiple search engines increases patients' chances of obtaining more relevant information rather than using a single search engine.

CONCLUSIONS

Our study shows the difficulties encountered by patients in obtaining information regarding knee arthroscopy and highlights the duty of knee surgeons in helping patients to identify the relevant and authentic information in the most efficient manner from the World Wide Web.

CLINICAL RELEVANCE

This study highlights the importance of the role of orthopaedic surgeons in helping their patients to identify the best possible information on the World Wide Web.

Ileal pouch-anal anastomosis: the Australasian experience

OBJECTIVE

The aim of this project was to establish and maintain an internet-based database of all ileal pouch procedures performed in major centres in Australasia.

METHOD

The initial three colorectal units contributing data are Auckland, northern Brisbane and Central Sydney Area Health Service. A web-based database was designed. The data collection method was tested on a subgroup of 20 patients to ensure functionality. Data were collected in five main categories: patient demographics, preoperative data, operative details, postoperative complications and functional results.

RESULTS

Initial data are presented for 516 patients [363 J, (70%), 133 W (26%), 16 S pouches (3%)]. There were two deaths within 30 days (0.4%). The anastomotic leak rate overall, in handsewn (HSA) and stapled anastomoses (SA) respectively was 5.0%, 8.5% and 3.3% (P=0.02 for difference HSA vs SA). Incidence of pouchitis was 20% (ulcerative colitis 23%, Crohn's disease 20%, indeterminate colitis 22%, familial adenomatous polyposis 9%). Incidence of anal stricture requiring intervention (11% overall) was significantly greater in HSAs than in SAs (16%vs 9%, P=0.02). Incidence of small bowel obstruction at any time postoperatively was 16%. Functional data were available for 234 patients. The median frequency of bowel actions during waking hours was significantly less in W pouches than in J pouches (four vs five, P=0.0005).

CONCLUSION

A national web-based database has been developed for access by all Australasian colorectal units. Initial Australasian data compare favourably with other international studies. Pouchitis continues to be a long-term problem. The leak rate and rate of late anal stricture requiring a procedure are higher if the anastomosis is handsewn rather than stapled. Functional results are better with the W pouch than with the J pouch.

Information about liver transplantation on the World Wide Web

Orthotopic liver transplant (OLTx) has evolved to a successful surgical management for end-stage liver diseases. Awareness and information about OLTx is an important tool in assisting OLTx recipients and people supporting them, including non-transplant clinicians. The study aimed to investigate the nature and quality of liver transplant-related patient information on the World Wide Web. Four common search engines were used to explore the Internet by using the key words 'Liver transplant'. The URL (unique resource locator) of the top 50 returns was chosen as it was judged unlikely that the average user would search beyond the first 50 sites returned by a given search. Each Web site was assessed on the following categories: origin, language, accessibility and extent of the information. A weighted Information Score (IS) was created to assess the quality of clinical and educational value of each Web site and was scored independently by three transplant clinicians. The Internet search performed with the aid of the four search engines yielded a total of 2,255,244 Web sites. Of the 200 possible sites, only 58 Web sites were assessed because of repetition of the same Web sites and non-accessible links. The overall median weighted IS was 22 (IQR 1 - 42). Of the 58 Web sites analysed, 45 (77%) belonged to USA, six (10%) were European, and seven (12%) were from the rest of the world. The median weighted IS of publications originating from Europe and USA was 40 (IQR = 22 - 60) and 23 (IQR = 6 - 38), respectively. Although European Web sites produced a higher weighted IS [40 (IQR = 22 - 60)] as compared with the USA publications [23 (IQR = 6 - 38)], this was not statistically significant (p = 0.07). Web sites belonging to the academic institutions and the professional organizations scored significantly higher with a median weighted IS of 28 (IQR = 16 - 44) and 24(12 - 35), respectively, as compared with the commercial Web sites (median = 6 with IQR of 0 - 14, p = .001). There was an Intraclass Correlation Coefficient (ICC) of 0.89 and an associated 95% CI (0.83, 0.93) for the three observers on the 58 Web sites. The study highlights the need for a significant improvement in the information available on the World Wide Web about OLTx. It concludes that the educational material currently available on the World Wide Web about liver transplant is of poor quality and requires rigorous input from health care professionals. The authors suggest that clinicians should pay more attention to take the necessary steps to improve the standard of information available on their relevant Web sites and must take an active role in helping their patients find Web sites that provide the best and accurate information specifically applicable to the loco-regional circumstances.

What questions do patients undergoing lower extremity joint replacement surgery have?

BACKGROUND

The value of the Internet to deliver preoperative education would increase if there was variability in questions patients want answered. This study's goal was to have patients consulting an orthopedic surgeon about undergoing either a total hip arthroplasty (THA) or a total knee arthroplasty (TKA) rate the importance of different questions concerning their care.

METHODS

We assembled questions patients might have about joint replacement surgery by analyzing the literature and querying a pilot group of patients and surgeons. Twenty-nine patients considering undergoing THA and 19 patients considering TKR completed a written survey asking them to rate 30 different questions, with a 5 point Likert scale from 1 (least important)--5 (most important).

RESULTS

For patients considering THA or TKR, the 4 highest rated questions were: Will the surgery affect my abilities to care for myself?, Am I going to need physical therapy?, How mobile will I be after my surgery?, When will I be able to walk normally again? The mean percentage disagreement was 42% for questions answered by TKR patients and 47% for the THA group. Some patients gave a high rating to questions lowly rated by the rest of the group.

CONCLUSIONS

Although there was enough agreement to define a core set of questions that should be addressed with most patients considering THA or TKA, some of the remaining questions were also highly important to some patients. The Web may offer a flexible medium for accommodating this large variety of information needs.