Vol No: 4 Issue No: 2 eISSN:
Dear Authors,
We invite you to watch this comprehensive video guide on the process of submitting your article online. This video will provide you with step-by-step instructions to ensure a smooth and successful submission.
Thank you for your attention and cooperation.
1Dept. of Hospital Administrations, St. John’s Medical College, Koramangala, Bangalore.
21 St. John’s Medical College, St. John’s National Academy of Health Sciences, Bangalore, Karnataka. 2 St. Francis Hospital, Ajmer, Rajasthan.
3St. John’s Medical College, St. John’s National Academy of Health Sciences, Bangalore, Karnataka.
4St. John’s Medical College, St. John’s National Academy of Health Sciences, Bangalore, Karnataka
*Corresponding Author:
Dept. of Hospital Administrations, St. John’s Medical College, Koramangala, Bangalore., Email: priyanka.rc@stjohns.in
Abstract
Background: Patients and their families may play a major role in the improvement of healthcare outcome. Modern healthcare scenario focuses on enhancing patient well-being with a closer participation between payer and provider. “Nothing about me is without me” is the true essence of healthcare which requires first-hand knowledge of the ailment, treatment options, risks and benefits and a host of other information for the patients to be completely involved in the care process.
Objectives: To assess the level of involvement of patients undergoing elective surgeries during the phases such as surgical decision making, written consent and post-surgical recovery.
Methodology: The present study was conducted at two tertiary care hospitals in India with a sample size of 50 each from the selected surgical specializations. Structured questionnaires were designed to obtain relevant data from the participants admitted under selected surgical specialisations. Data was collected to assess their involvement at three phases viz., pre surgical decision making, written consent and post-surgical recovery phases. Data from all three phases were compiled and the involvement of patients was computed in terms of percentage using descriptive statistics. Chi-square test was performed to determine the association between patient involvement and demographic variables. (Significance level at 5%).
Results: The study showed good involvement of patients at all the three levels with ≥75% score. However, association was not found between demographic variables and the level of involvement.
Conclusion: Many patients felt the need to receive more information regarding post-operative recovery time, post-operative diet, care for incision site and post-operative movement or exercises.
Keywords
Downloads
-
1FullTextPDF
Article
Introduction
Patients and their families may play a major role in the improvement of healthcare outcome. Modern healthcare scenario focuses on enhancing patient well-being with a closer participation between payer and provider.1 Willingness of patients towards involvement in decision making related to treatment options may vary from case to case.2 However making a patient fully informed regarding their ailment and treatment options will certainly make the care more patient centric. Patients’ participation in decision making towards patient care and treatment has become a prerequisite for quality care worldwide.3 Patients, as consumers, purchase services and hence demand availability, quality, and service. Better involvement and engagement of patients in the care process will certainly bring more satisfaction in the entire process. Experts in the field view shared decision making as a key element of good healthcare and patient engagement. The pace of change is slow in India and many other countries in the world.4 Patients will actively participate in their own health care process and would more carefully follow their own care plan, when they are considered as equal partners in healthcare.5 Patient participation results in improved health outcome, enhanced quality of life, more compliance and cost-effectiveness of services and further, patient involvement in the form of shared decision-making may enhance efficiency of the healthcare systems at a micro level.6 People living in India practice different religions, speak different languages, and lead different lifestyles. In addition to this, the value system and the cultural diversity makes it even more essential for the patients to receive complete information regarding the care plan to enable total involvement in the care process.
This study was aimed at identifying the patient engagement during the three phases of surgical process viz., pre-surgical decision making, consent signing and post-surgical recovery phases, from two tertiary care hospitals located in different geographical locations in India.
Materials and Methods
The study was conducted for a duration of one year (2020- 2021) after obtaining the ethical approval.
This is a descriptive study and was carried out with primary data collected from 100 patients (50 patients from each hospital) admitted for elective surgical procedures under General surgery, Neurosurgery, Orthopaedics, Paediatrics wards in the tertiary care hospitals. Patients admitted for emergency surgery and unable to communicate due to post-surgical trauma were excluded from the study. Structured questionnaires were used to collect data from all three phases. The questionnaire consisted of relevant questions to the particular phase (Refer tables 5, 6 and 7) and was accompanied by five point scale system 1. Fully agree / Highly satisfied. 2. Agree / Satisfied. 3. Neutral. 4. Disagree / Not satisfied and 5. Fully disagree / Highly dissatisfied.
Subject information sheet and the informed consent forms were provided to the admitted patients. Questionnaires were provided only to the patients willing to participate in the study. Subject information sheet, informed consent form and questionnaires were translated in the vernacular languages for patients unable to communicate in English.
The data from all the questionnaires were compiled. A mean score of 75 was decided as a cut off score to decide the level of involvement by patients at each phase. A score of ≥75 was considered as high involvement and a score of <75 was considered as low involvement. Chi square test was performed using SPSS software and the association between the demographical variables like age, gender, qualification, occupation and the level of involvement was assessed at 5% level of significance.
Results
Frequency distributions of the demographic data, demographical variables, and patient involvement score at three phases of the study are shown in Tables 1-4 and the question wise distribution of patient involvement scores at three phases is shown in Tables 5-7.
Discussion
The active patient participation results in improved health outcome, enhanced quality of life, more compliance and cost-effectiveness of services. When they are regarded as equal partners in healthcare, they will actively participate in their own health care process and would more carefully follow their own care. The concept of patient engagement has been increasingly recognized as a key component in the redesign of care process. The widespread consumer movement demands the same. Nevertheless, not keeping the patient duly informed regarding his or her care plan might even lead to litigation against the care provider. The present study which was focused to evaluate patient participation in shared decision making (surgical decision) and their level of involvement at consent signing and post-operative recovery phase reinstates that there is a growing shift from physician-centred care to patient-centred care.
A study carried out in Auckland, demonstrated considerable number of patients being not totally satisfied with the amount of information given prior to surgery. While only one half of the patients received adequate information about the risks and complications of the proposed operation, one fourth of the patients did not recall being informed regarding the risks or dangers of the operation.4 The study also demonstrated that a significant number of patients were not able to recall the risks associated with the surgery. Further, a significant number of patients had not been provided with the alternate options to surgery.4 The present study demonstrated a considerable number of patients (Q.N-03: Table 5) receiving adequate information regarding the risks associated with the surgery. The information helped them to go ahead with the proposed plan of surgery only after being (Q.N- 05: Table 5) completely convinced regarding the necessity of the surgical procedure. Nevertheless, many patients (Q.N-01: Table 5) in our study received alternate care options to the surgery.
The present study also reported considerable number of patients receiving different treatment options by the treating physicians (Q.N-01: Table 5). These results agree with other studies showing similar results.7.8
The present study reported considerable number of patients requiring adequate information pertaining to post-operative recovery time (Q.N-09: Table 7), the post-operative diet (Q.N-11: Table 7), instructions on care for the incision site (Q.N-12: Table7) and exercises pertaining to post-operative mobility (Q.N-13: Table 7). These results are different from the results of a study which revealed, considerable number of patients receiving adequate information on post operative recovery plan from their care providers directly.9 Though the present study showed overall good involvement of patients (Table 4) in the post-operative recovery phase, detailed information pertaining to post-operative care plan might have been an area of concern probably due to the covid era during which the present study was conducted.
Our study reported a large number of patients (Q.N-07: Table 6) receiving information from the consent form in their vernacular languages. The patients (Q.N-08: Table7) also opined that they signed the information consent form only after receiving satisfactory information related to all aspects of the surgery. Arguably, similar scores of our study were reported in another study, where the written informed consent form and the surgery related information was explained to a considerable number of patients to enable proper understanding by the patients.10 Our study did not find any significant association between the demographical variables such as age, gender, occupation, qualification, and the level of involvement by patients across the pre surgical decision making, consent signing and post-operative recovery phases.
Conclusion
There was high involvement of patients at pre-surgical, consent signing and post-surgical recovery phases. Many patients agreed on adequate information being imparted to them on various aspects of the surgical processes including self-care practices, infection control and medical management at the post-operative phase. However, patients expressed the need to strengthen the information to patients about post-operative recovery time, post-operative diet, and post-operative exercises as these areas play a significant role in faster recovery and shorter hospital stay. There was no significant association between the demographic variables and the level of involvement by patients across the three phases.
Limitations
Covid era prevented us from having a higher number of participants from each hospital.
Conflicts of Interest
Nil
Acknowledgement
We acknowledge the contribution of Mr. Micheal John from St. John’s Medical College for helping us with data analysis.
Supporting File
References
- Ambigapathy R, Chia YC, Ng CJ. Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic. BMJ Open 2016;6(1):e010063.
- McKinstry B. Do patients wish to be involved in decision making in the consultation? A cross-sectional survey with videovignettes. BMJ 2000;321(7265):867-71.
- Politi MC, Dizon DS, Frosch DL, Kuzemchak MD, Stiggelbout AM. Importance of clarifying patients desired role in shared decision making to match their level of engagement with their preferences. BMJ 2013;347:f7066.
- McKeague M, Windsor JA. Patients’ perception of the adequacy of informed consent: a pilot studyof elective general surgical patients in Auckland. N Z Med J 2003;116(1170):U355.
- Heggland LH, Øgaard T, Mikkelsen A, Hausken K. Patient participation in surgical treatment decision making from the patients’ perspective: validation of an instrument. Nurs Res Pract 2012;2012:939675.
- Babac A, von Friedrichs V, Litzkendorf S, Zeidler J, Damm K, von derSchulenburg JM. Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice BMC medical informatics and decision making. 2019;19(1):188.
- Mah HC, Muthupalaniappen L, Chong WW. Perceived involvement and preferences in shared decision-making among patients with hypertension. Fam Pract 2016;33(3):296–301.
- Prochazka AV, Fink AS, Bartenfeld D, Henderson WG, Nyirenda C, Webb A, et al. Patient perceptions of surgical informed consent: is repeat back helpful or harmful? J Patient Saf 2014;10(3):140-5.
- McDonnell J, Heynsbergh N, Oxley S, Botti M, Hutchinson A. Opportunities for patients to engage in postoperative recovery following cardiac surgery: a systematic narrative review. Patient Educ Couns 2020;103(10):2095-2106.
- Agozzino E, Borrelli S, Cancellieri M, Carfora FM, Di Lorenzo T, Athena F. Does written informed consent adequately inform surgical patients? A crosssectional study. BMC Med Ethics 2019;20(1):1