Continuous care and empathic anaesthesiologist attitude in the preoperative period: impact on patient anxiety and satisfaction
ABSTRACT Continuous care (one anaesthesiologist per patient) and anaesthesiologist empathy at the preoperative visit could affect patient anxiety and satisfaction. We tested both unproven issues in a population at increased risk of anxiety and dissatisfaction.
In this single-blinded single-centre study, 136 women undergoing gynaecologic day-care surgery were sequentially randomized into four groups: (i) preoperative visit by an anaesthesiologist with either an empathic or a neutral attitude, and (ii) receiving either continuous or divided care (preoperative visit and anaesthesia performed by two different anaesthesiologists). Preoperative anxiety and wish for information were rated before and after the preoperative visit. Patient appraisal of the anaesthesiologist's attitude and the quality of care provided was obtained in the operating theatre.
An empathic attitude at the preoperative visit significantly improved the perception of both the anaesthesiologist attitude (P<0.001) and the quality of information delivered (P<0.001), compared with a neutral anaesthesiologist attitude. Empathic attitude tended to decrease patient anxiety. In the operating theatre, patients who had the same anaesthesiologist (continuous care) exhibited greater satisfaction levels regarding anaesthesiologist behaviour and quality of care (P<0.001). Principal component analysis confirmed these findings, revealing that an empathic preoperative visit was linked to a reduction in preoperative patient anxiety.
The 'one patient, one anaesthesiologist' model, in addition to ensuring sufficient time for open discussion and questions at the preoperative visit, improved patient satisfaction.
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ABSTRACT: PURPOSE: To review systematically the impact of clinicians' personality and observed interpersonal behaviors on the quality of their patient care. DATA SOURCES: We searched MEDLINE, EMBASE and PsycINFO from inception through January 2014, using both free text words and subject headings, without language restriction. Additional hand-searching was performed. STUDY SELECTION: The PRISMA framework guided (the reporting of) study selection and data extraction. Eligible articles were selected by title, abstract and full text review subsequently. DATA EXTRACTION: Data on study setting, participants, personality traits or interpersonal behaviors, outcome measures and limitations were extracted in a systematic way. RESULTS OF DATA SYNTHESIS: Our systematic search yielded 10 476 unique hits. Ultimately, 85 studies met all inclusion criteria, 4 on clinicians' personality and 81 on their interpersonal behaviors. The studies on interpersonal behaviors reported instrumental (n = 45) and affective (n = 59) verbal behaviors or nonverbal behaviors (n = 20). Outcome measures in the studies were quality of processes of care (n = 68) and patient health outcomes (n = 35). The above categories were non-exclusive. The majority of the studies found little or no effect of clinicians' personality traits and their interpersonal behaviors on the quality of patient care. The few studies that found an effect were mostly observational studies that did not address possible uncontrolled confounding. CONCLUSIONS: There is no strong empirical evidence that specific interpersonal behaviors will lead to enhanced quality of care. These findings could imply that clinicians can adapt their interactions toward patients' needs and preferences instead of displaying certain specific behaviors per seInternational Journal for Quality in Health Care 01/2008; 26(4):426-481. DOI:10.1093/intqhc/mzu055 · 1.58 Impact Factor
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ABSTRACT: A preanesthetic visit can increase a patient's satisfaction. However, it is uncertain whether a preanesthetic visit by an anesthesiology resident can achieve the goal. We studied the time distribution for content of preanesthetic interviews (PI) and evaluated the patient's satisfaction with the PI. We recorded the PI duration of 200 patients by a voice recorder. The degrees of patient satisfaction with the PI and the changes of anxiety level after the PI were quantified by a questionnaire. We analyzed the time distribution for content of the PI and the correlation between patient characteristics and PI duration or a patient's satisfaction. The total PI duration was 184 (134-286) sec (median, 25-75%), and the time distributions for content of the PI were 8 (5-10) of greeting, 45 (23-70) of history taking, 15 (10-20) of physical examination, 50 (25-98) for obtainingan informed consent, 20 (10-30) of explanation for anesthetic planning, 15 (5-28) for explanation of patient controlled analgesia, and 10 (0-4) sec for questions and answers. Age, ASA physical status, and educational level were correlated with PI duration (P < 0.001). The patient's level of satisfaction was "very satisfied" in 39%, "satisfied" in 50%, and "moderate" in 11% of interviews. The anxiety level was "decreased" in 50%, "increased" in 8%, and "not changed" in 42% of patients. Although the duration of a PI given by residents was a relatively short, 89% of patients of were satisfied with the interview. The PI took a longer time to complete in patients of older age, higher ASA physical status, or lower educational levels.Korean journal of anesthesiology 03/2012; 62(3):220-4. DOI:10.4097/kjae.2012.62.3.220
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ABSTRACT: INTRODUCTION:: Evaluating patient-reported outcomes is complex. These difficulties may explain weaknesses with some existing tools: mainly, they rely on expert instead of patient views or are not metrically sound. The purpose of this study was to develop and validate a multidimensional self-reported questionnaire, specifically assessing the satisfaction of patients undergoing regional anesthesia, Evaluation du Vécu de l'Anesthésie LocoRégionale (EVAN-LR). METHODS:: Patients included underwent various surgical procedures under regional anesthesia. The questionnaire structure was identified by principal component factor analyses and interitem, item-dimension, and interdimension correlations. The authors assessed external validity by studying the relationships between potential dimensions of EVAN-LR and validated instruments such as Amsterdam Preoperative Anxiety and Information Scale, State Trait Anxiety Inventory, and specific visual analog scales. Internal consistency reliability was assessed by Cronbach α. RESULTS:: We included 390 patients for the validation phase. The EVAN-LR comprises 19 items, structured in a global index and five dimensions: Attention, Information, Discomfort, Waiting, and Pain. The consequences of staying alert during regional anesthesia were specifically addressed by two items. Female sex was associated with significantly lower Information score. Patients with American Society of Anesthesiologists physical status below 2 had a significantly lower Attention score. Patients older than 55 years showed higher satisfaction scores for most dimensions. EVAN-LR poorly correlated with premedication. CONCLUSION:: The authors have validated a new measuring tool assessing patient satisfaction within the perioperative period surrounding regional anesthesia. The multidimensional structure of EVAN-LR allows it to be used as a clinical tool for improving anesthesia management.Anesthesiology 12/2012; 118(1). DOI:10.1097/ALN.0b013e31827469f2 · 6.17 Impact Factor