Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
Am J Obstet Gynecol. 2017 Aug;217(2):179.e1-179.e7. doi: 10.1016/j.ajog.2017.04.017. Epub 2017 Apr 18.
Patient preparedness for pelvic reconstructive surgery has important implications for patient satisfaction and the perception of improvement after surgery. The ideal method in which to optimally prepare patients for surgery has not been determined.
The objective of the study was to evaluate the impact of a preoperative patient education video on patient preparedness prior to sacrocolpopexy as measured by a preoperative preparedness questionnaire.
We performed a single-blind, randomized, stratified clinical trial at a single academic center evaluating the use of a preoperative patient education video as an adjunct to preoperative counseling on patient preparedness. Eligible patients presenting for their preoperative appointment prior to undergoing pelvic reconstructive surgery were randomized to watch a preoperative video vs usual care. Preoperative questionnaires assessing patient preparedness, understanding, perception of time, and actual time spent with a health care team were administered at the end of this visit. The primary outcome was patient preparedness for pelvic reconstructive surgery as measured by a preoperative preparedness questionnaire. Secondary outcomes included actual time spent during the physician-patient encounter, perception of time spent with the health care team, and identification of patient factors associated with patient preparedness.
Of the total 100 recruited patients, 52 were randomized to the video group and 48 to the usual-care group. The use of the video did not increase overall patient preparedness (71.1% with video vs 68.8% usual care, P = .79) prior to surgery. The use of the video did not decrease the amount of time spent during the physician-patient encounter (16.9 ± 5.6 min vs 17.1 ± 5.4 min, P = .87). There was a significant association between patient preparedness and perception that the health care team spent sufficient time with the patient (89.5% vs 10.5%; P < .001), but no association was observed between preparedness and actual time spent (17.4 ± 5.4 min vs16.5 ± 5.5 min, P = .47). Those with a history of a previous surgery (82.1% vs 33.3%, P = .002) and those with more significant apical prolapse (0.6 ± 4.6 vs -1.6 ± 3.9, P = .05) were more likely to report feeling prepared for surgery.
The majority of patients undergoing pelvic surgery at our institution felt prepared prior to undergoing surgery. The use of preoperative education video did not increase overall patient preparedness for surgery. Greater preparedness was associated with patient perception of how much time the health care team spent with the patient but not actual time spent.
患者对骨盆重建手术的准备情况对患者满意度和术后改善的感知有重要影响。尚未确定优化患者手术准备的理想方法。
本研究旨在通过术前准备问卷评估术前患者教育视频对骶骨直肠固定术前患者准备情况的影响。
我们在一家学术中心进行了一项单盲、随机、分层临床试验，评估术前患者教育视频作为术前咨询的辅助手段对患者准备情况的影响。符合条件的患者在接受骨盆重建手术前就诊时，随机分为观看术前视频组和常规护理组。在就诊结束时，患者会填写一份评估患者术前准备情况、理解程度、对时间的感知以及实际与医疗团队花费时间的术前问卷。主要结局是通过术前准备问卷评估患者对骨盆重建手术的准备情况。次要结局包括医患会面期间实际花费的时间、患者对与医疗团队共度时间的感知以及确定与患者准备情况相关的患者因素。
在总共招募的 100 名患者中，52 名被随机分配到视频组，48 名被分配到常规护理组。手术前，使用视频并未增加患者整体准备程度（71.1%的视频组和 68.8%的常规护理组，P=0.79）。使用视频并没有减少医患会面时间（16.9±5.6 分钟与 17.1±5.4 分钟，P=0.87）。患者的准备情况与患者认为医疗团队与患者共度的时间充足之间存在显著关联（89.5%与 10.5%；P<0.001），但准备情况与实际花费的时间之间没有关联（17.4±5.4 分钟与 16.5±5.5 分钟，P=0.47）。有既往手术史的患者（82.1%与 33.3%，P=0.002）和有更严重的穹隆脱垂患者（0.6±4.6 与-1.6±3.9，P=0.05）更有可能报告对手术有准备。
在我们机构接受骨盆手术的大多数患者在手术前都感到有准备。术前教育视频的使用并未增加患者对手术的总体准备程度。更高的准备程度与患者对医疗团队与患者共度时间的感知相关，而与实际花费的时间无关。
