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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

15.09.2020 | Reports of Original Investigations

Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study

verfasst von: Emily Hladkowicz, MA, Ed, David Yachnin, MSc, Laura Boland, PhD, Kumanan Wilson, MD, FRCPC, Annette McKinnon, Kira Hawrysh, Terry Hawrysh, Cameron Bell, B.Eng, Katherine Atkinson, PhD(c), Carl van Walraven, MD, FRCPC, Monica Taljaard, PhD, Kednapa Thavorn, BPharm, PhD, Dawn Stacey, PhD, Homer Yang, MD, FRCPC, Christopher Pysyk, MD, FRCPC, Husein Moloo, MD, FRCSC, Doug Manuel, MD, FRCPC, David MacDonald, MD, FRCPC, Luke T. Lavallée, MD, FRCSC, Sylvain Gagne, MD, FRCPC, Alan J. Forster, MD, FRCPC, Gregory L. Bryson, MD, FRCPC, Daniel I. McIsaac, MD, FRCPC

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2020

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Abstract

Purpose

Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk communication tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care.

Methods

We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application’s materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability.

Results

We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (− 1.9%; 95% CI, − 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists.

Conclusion

Exposure to a patient-facing, personalized risk communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery.

Trial registration

www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.

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Titel: Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study
verfasst von: Emily Hladkowicz, MA, Ed
David Yachnin, MSc
Laura Boland, PhD
Kumanan Wilson, MD, FRCPC
Annette McKinnon
Kira Hawrysh
Terry Hawrysh
Cameron Bell, B.Eng
Katherine Atkinson, PhD(c)
Carl van Walraven, MD, FRCPC
Monica Taljaard, PhD
Kednapa Thavorn, BPharm, PhD
Dawn Stacey, PhD
Homer Yang, MD, FRCPC
Christopher Pysyk, MD, FRCPC
Husein Moloo, MD, FRCSC
Doug Manuel, MD, FRCPC
David MacDonald, MD, FRCPC
Luke T. Lavallée, MD, FRCSC
Sylvain Gagne, MD, FRCPC
Alan J. Forster, MD, FRCPC
Gregory L. Bryson, MD, FRCPC
Daniel I. McIsaac, MD, FRCPC
Publikationsdatum: 15.09.2020
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2020
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-020-01809-y

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Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study