术前教育及重症监护病房参观对择期心脏手术后重症监护病房患者及家属满意度和焦虑的影响：一项随机对照试验

Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial.

作者信息

Lai Veronica Ka Wai, Ho Ka Man, Wong Wai Tat, Leung Patricia, Gomersall Charles David, Underwood Malcolm John, Joynt Gavin Matthew, Lee Anna

机构信息

Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.

Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

出版信息

BMJ Qual Saf. 2021 Mar;30(3):228-235. doi: 10.1136/bmjqs-2019-010667. Epub 2020 Apr 22.

DOI:10.1136/bmjqs-2019-010667

PMID:32321777

Abstract

BACKGROUND

Preoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care unit (ICU) as well as in family members.

OBJECTIVE

To assess the effect of a preoperative multifaceted education intervention on patient and family satisfaction levels in the ICU and measures of perioperative patients' anxiety and depression.

TRIAL DESIGN

Single-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation.

PARTICIPANTS

100 elective coronary artery bypass grafting±valve surgery patients and their family members.

INTERVENTIONS

Preoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control).

OUTCOMES

Patient and family satisfaction levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires (0-100), respectively; change in perioperative anxiety and depression scores between 1 day presurgery and 3 days postsurgery.

RESULTS

Among 100 (50 treatment, 50 control) patients and 98 (49 treatment, 49 control) family members, 94 (48 treatment, 46 control) patients and 94 (47 treatment, 47 control) family members completed the trial. Preoperative education was associated with higher overall patient (mean difference (MD) 6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI 3.8 to 16.3) satisfaction scores. There was a weak association between preoperative education and a reduction in patient's anxiety scores over time (MD -1.7, 95% CI -3.5 to 0.0). However, there was no evidence of a treatment effect on patient's depression scores over time (MD -0.6, 95% CI -2.3 to 1.2).

CONCLUSION

Providing comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients' anxiety levels.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15006971.

摘要

背景

术前教育可能有助于参与者在心理上为手术做好准备，但对于需要在重症监护病房（ICU）接受术后护理的患者及其家属，此类准备的效果鲜有评估。

目的

评估术前多方面教育干预对ICU患者及其家属满意度以及围手术期患者焦虑和抑郁指标的影响。

试验设计

单中心、双臂、平行、优效性随机对照试验。ICU的医护人员和结果评估者对治疗分配情况不知情。

参与者

100例行择期冠状动脉搭桥术±瓣膜手术的患者及其家属。

干预措施

除标准护理（治疗）外，术前教育包括观看视频和参观ICU（治疗组），与标准护理（对照组）对比。

结果

采用经过验证的PS-ICU23和FS-ICU24问卷（0-100分）分别评估患者和家属对ICU的满意度；比较术前1天和术后3天围手术期焦虑和抑郁评分的变化。

结果

100例患者（50例治疗组，50例对照组）和98名家属（49名治疗组，49名对照组）中，94例患者（48例治疗组，46例对照组）和94名家属（47例治疗组，47例对照组）完成了试验。术前教育与患者总体满意度（平均差值（MD）6.7，95%置信区间0.2至13.2）和家属满意度（MD 10.0，95%置信区间3.8至16.3）较高相关。随着时间推移，术前教育与患者焦虑评分降低之间存在弱相关性（MD -1.7，95%置信区间 -3.5至0.0）。然而，没有证据表明随着时间推移治疗对患者抑郁评分有影响（MD -0.6，95%置信区间 -2.3至1.2）。