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

Abstract

BackgroundPreoperative 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.ObjectiveTo 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 designSingle-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation.Participants100 elective coronary artery bypass grafting±valve surgery patients and their family members.InterventionsPreoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control).OutcomesPatient 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.ResultsAmong 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).ConclusionProviding comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients’ anxiety levels.Trial registration numberChiCTR-IOR-15006971.

Influence on Depression, Anxiety, and Satisfaction of the Relatives’ Visit to Intensive Care Units prior to Hospital Admission for Elective Cardiac Surgery: A Randomized Clinical Trial

“…These findings were unexpected because new information could have provided the patients and relatives with more psychological control in these situations, decreasing their levels of anxiety and depression, and getting better levels of satisfaction, if the information had been provided earlier, or using other types of information (i.e., videos or photos). Some possible reasons that could explain the poor satisfaction secondary to the patient's relatives' visit prior to elective cardiac surgery hospital admission may be that expectations and views from both relatives and patients should be sought formally before ICU admission to intensive care and preoperative education should be included in addition to an ICU tour [ 31 ]. In addition, clinical outcomes of the patients were not measured in our study and patients' outcomes could play a role in decreased satisfaction of the families, in spite of the received care seems to be more related to patient's care than clinical outcomes, which could have influenced relatives' satisfaction [ 32 ].…”

Influence of Preoperative Anxiety Level on Postoperative Pain After Cardiac Surgery

“…In addition it is the responsibility of doctor and nurse to educate patients about the procedure, and also take appropriate interventions, in order to reduce anxiety and post-operative morbidities. Another approach is to give ICU tour to patient and families before surgery in order to improve satisfaction and reduce anxiety (33).…”

A pilot randomised controlled trial of patient education to improve umbilical cleanliness prior to laparoscopic surgery

“…This is particularly so given that the benefits of perioperative education are known to extend beyond the intervention focus to reducing overall patient anxiety and improving patient satisfaction. 15,16 It is also possible that the true effect size is underestimated due to control participants cleaning their umbilici preoperatively after being informed of the study through the consent process.…”

“…The high caseload of laparoscopic surgeries and negligible cost and risk of harm associated with the intervention mean that even a relatively high number needed to treat would still support translation to practice. This is particularly so given that the benefits of perioperative education are known to extend beyond the intervention focus to reducing overall patient anxiety and improving patient satisfaction 15,16 . It is also possible that the true effect size is underestimated due to control participants cleaning their umbilici preoperatively after being informed of the study through the consent process.…”