Do patient information booklets increase perioperative anxiety?

Abstract

Patient attitudes to medical information are changing. We audited patient attitudes to an information leaflet provided at the preadmission clinic as part of standard day-case protocol. The booklet is a simplified version of the booklet Anaesthesia and Anaesthetists--Information for Patients and Relatives published in London, UK, by the Association of Anaesthetists of Great Britain & Ireland. One hundred and three patients were surveyed before surgery over a 2-month period using an anonymous questionnaire. Of the 96% of patients who read the booklet provided, 99% found it helpful to some degree. Thirty-five per cent of patients found it worried them. Thirty-two per cent discussed the information with others but only 3% discussed the information provided with the anaesthetist. Although patients like to receive information about the process of anaesthesia, we must be careful that by providing it in an inappropriate form, e.g. as a leaflet, we do not increase their preoperative anxiety.

Conscious surgery: influence of the environment on patient anxiety

“…For example, the anaesthetist explaining events and being given prior notice of proceedings (sequential order of events) were beneficial in that it helped to reduce anxiety (Table 3). Other studies have likewise revealed such information and choice to be crucial in modern elective surgery (McKenna 1997, Ward et al 2007, Gillies and Baldwin 2001. However, debate frequently occurs regarding the ideal time for the anaesthetist to visit patients to impart such information.…”

Do the Patients Read the Informed Consent?

“…It has been documented that, in addition to simple drawings and shapes, giving images of surgical intervention and anaesthesia processes via informative leaflets or multimedia means like CD and DVD to the patients does not increase the uneasiness of the patients and actually contributes to the operation being better understood (25,26).…”

A reply

“…An attempt to understand why chronic b-blockade is potentially beneficial in cardiac surgery [1,2] and not in noncardiac surgery [3][4][5][6][7][8], may help identify factors associated with an improved peri-operative outcome in chronically b-blocked patients. While patients undergoing non-cardiac surgery were more likely to be b-blocked for angina and hypertension and die of ischaemicrelated causes in the peri-operative period [3], a larger proportion of the cardiac surgery patients had heart failure [1] and were more likely to die of heart failure than of ischaemic causes [2].…”

“…While patients undergoing non-cardiac surgery were more likely to be b-blocked for angina and hypertension and die of ischaemicrelated causes in the peri-operative period [3], a larger proportion of the cardiac surgery patients had heart failure [1] and were more likely to die of heart failure than of ischaemic causes [2]. Thus, chronic b-blockade in patients with angina or hypertension without severe myocardial dysfunction may not alter peri-operative outcome [3]. Indeed, the lowering of the ischaemic threshold [9] is potentially detrimental and 'clamping the heart rate' may be desirable.…”

“….............................................................................................................................................................................................................. [1]. Some anaesthetists may use such hypnotherapeutic language as part of their patient communication but few will have studied why some forms of language are effective in helping patients relax while other communications or explanations may actually increase anxiety [2,3]. An example follows of how one might communicate some information following introducing oneself as the anaesthetist: 'I am here to put you to sleep for your surgery' implies subconsciously that the patient might not wake up.…”