Continuous care and empathic anaesthesiologist attitude in the preoperative period: Impact on patient anxiety and satisfaction

Pôle d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Université d'Angers, Angers, France.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 03/2011; 106(5):680-6. DOI: 10.1093/bja/aer034
Source: PubMed


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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    • "Although some studies report that physiological and music intervention is effective in reducing anxiety levels,5,6,7,8 few studies have examined the effects of physiological and music intervention on perioperative safety in elderly patients. For example, psychological intervention and direct communication with patients by anesthetists and nurses before surgery was found to effectively reduce patient anxiety and improve patient satisfaction.7 "
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    ABSTRACT: Purpose The aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels. Materials and Methods Fourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music intervention, and the other was the control. The intervention group underwent psychological intervention and listening to music for 30 min before surgery. Results The mean change in HRV as determined by low frequency (LF) power measurements. After the intervention, the ratio of mean LF to high frequency (HF) power decreased significantly in the intervention group compared to before the intervention (p<0.05). In the control group, mean LF measurements and the ratio of LF:HF did not change significantly. In the intervention group, mean HF power was significantly higher after the procedure than before (p<0.01). Moreover, the mean self-rating anxiety score of the intervention group decreased after the procedure compared to before (p<0.05). The mean visual analogue score of the intervention group 6 hours after surgery was significantly lower than that of the control group (p<0.01). Conclusion Perioperative psychological and music interventions can reduce anxiety and postoperative pain in elderly patients.
    Full-text · Article · Jul 2014 · Yonsei Medical Journal
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    • "Besides those metrical aspects, assuming that APAIS is now validated in Dutch, English, Japanese, German and French language, the next step is probably a broader integration of patient anxiety in care process. Early screening of anxious patients could enable specific strategies to improve their experience of the perioperative period [24]. As an example we could imagine basing the premedication strategies upon the APAIS score by giving sedatives just before surgery to the most anxious patients. "
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    ABSTRACT: Background Most patients are anxious before surgery. The level of preoperative anxiety depends on several factors and merits an objective evaluation. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-report questionnaire comprising six questions that have been developed and validated to evaluate the preoperative anxiety of patients. This global index assesses three separate areas: anxiety about anaesthesia, anxiety about surgery, and the desire for information. The purpose of this study was to translate the APAIS into French and to evaluate the psychometric properties of the French version of the APAIS. Methods The process consisted of two steps. The first step involved the production of a French version of the APAIS that was semantically equivalent to the original version. In the second step, we evaluated the psychometric properties of the French version, including the internal consistency and reliability, the differential item functioning, and the external validity. Participants older than 18, undergoing elective surgery (except obstetric), able to understand and read French, and able to complete a self-report questionnaire were eligible for inclusion in the study. A forward-backward translation was performed. The psychometric evaluation covered three domains: internal validity, external validity, and acceptability. Within 4–48 h after surgery, the patients were asked to complete the “Evaluation du Vécu de l’ANesthésie” questionnaire” (EVAN) questionnaire, which is a validated, multi-dimensional questionnaire that assesses the patient’s experiences in the perioperative period. Results A database with 175 patients was created. The principal component factor analysis revealed the same three-dimensional structure as the original scale. The confirmatory factor analysis showed a strong fit with a root mean square error of approximation of 0.069 and a comparative fit index of 1.00. The amount of differential item functioning (DIF) between the subgroups of patients (i.e., based on age, gender, type of anaesthesia or surgery, premedication, ASA physical status, and ambulatory course) was low. The APAIS was strongly correlated with the dimensions of the EVAN. Each dimension had a low proportion of missing values (ranging from 0.6 to 2.9%), which indicates good acceptability of the questionnaire. Conclusions The French version of the APAIS is valid and reliable. The availability of this tool enables the evaluation of anxiety in French patients undergoing anaesthesia.
    Full-text · Article · Oct 2013 · Health and Quality of Life Outcomes
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    • "However, there are few studies for the duration of the preanesthetic visit or interview. Soltner et al. [11] reported that the preanesthetic consultation duration took ~10 min in patients undergoing a day-care gynecologic procedure. In the other study [12] for the usefulness of video about general information onanesthesia before the interview, the interview duration without video was < 20 min. "
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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.
    Full-text · Article · Mar 2012 · Korean journal of anesthesiology
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