Walker Marc E, Chuang Carolyn, Moores Craig R, Webb Matthew L, Buonocore Samuel D, Grant Thomson J
* Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA.
J Hand Surg Asian Pac Vol. 2018 Mar;23(1):11-17. doi: 10.1142/S2424835518500017.
The purpose of this study was to assess impact of the surgeon consultation and informed consent process on patient education in an international hand surgery mission compared with a US academic hand surgery practice. These two groups were selected to evaluate communication difficulties in a surgical mission setting compared with standard of care in a high-income country.
A multi-part survey was administered to patients presenting to a hand surgery mission during March 2012 and new patients of a university hand center in a 3-month period during 2011. Surveys were administered prior to and following surgeon consultation with one fellowship-trained hand surgeon. The survey assessed knowledge of basic hand anatomy, physiology, disease, individual diagnosis, and surgical risks.
71 patients participated in the study (university n=36, mission n=35). Pre-consultation quiz score averaged 58% in the university group versus 27% in the mission group. Post-consultation quiz scores averaged 62% in the university group versus 40% in the mission group. Only the mission group's quiz score increase was statistically significant. 93% of the university group reported learning about their condition and diagnosis, but only 40% demonstrated correct insight into their diagnosis. In the mission group, 73% reported learning about their condition and diagnosis while 53% demonstrated correct insight into their diagnosis. Although all consultations involved discussion of surgical risks, only 62% of the university group and 52% of the mission group recalled discussing surgical risks.
The hand surgeon consultation was more effective in improving hand knowledge in the surgery mission group compared to in a university hand practice. This suggests that the surgeon consultation should be pursued despite communication barriers in surgical missions. However, the discrepancy between patient perception of knowledge gains and correct insight into diagnosis, and the deficit of patient retention of surgical risks need to be improved.
本研究的目的是评估与美国学术性手部外科实践相比，外科医生会诊及知情同意过程对国际手部外科医疗任务中患者教育的影响。选择这两组来评估外科医疗任务环境中的沟通困难与高收入国家医疗标准之间的差异。
对2012年3月前往手部外科医疗任务的患者以及2011年3个月期间大学手部中心的新患者进行了多部分调查。在一名接受过专科培训的手部外科医生会诊之前和之后进行调查。该调查评估了基本手部解剖学、生理学、疾病、个体诊断和手术风险方面的知识。
71名患者参与了研究（大学组n = 36，医疗任务组n = 35）。大学组会诊前测验平均得分58%，而医疗任务组为27%。大学组会诊后测验平均得分62%，而医疗任务组为40%。只有医疗任务组的测验得分增加具有统计学意义。93%的大学组患者报告了解了自己的病情和诊断，但只有40%对自己的诊断有正确的认识。在医疗任务组中，73%的患者报告了解了自己的病情和诊断，而53%对自己的诊断有正确的认识。尽管所有会诊都涉及手术风险的讨论，但只有62%的大学组患者和52%的医疗任务组患者回忆起讨论过手术风险。
与大学手部外科实践相比，手部外科医生会诊在提高医疗任务组患者的手部知识方面更有效。这表明，尽管外科医疗任务中存在沟通障碍，但仍应进行外科医生会诊。然而，患者对知识获取的认知与对诊断的正确认识之间的差异，以及患者对手术风险的记忆不足需要得到改善。
