Emma P Harris1, David B MacDonald2, Laura Boland3, Sylvain Boet1,4,5, Manoj M Lalu1,4,6, Daniel I McIsaac7,8,9,10. 1. Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada. 2. Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada. 3. Population Health, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. 4. Ottawa Hospital Research Institute, Ottawa, Canada. 5. Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada. 6. Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada. 7. Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada. dmcisaac@toh.ca. 8. Ottawa Hospital Research Institute, Ottawa, Canada. dmcisaac@toh.ca. 9. School of Epidemiology, & Public Health, University of Ottawa, Ottawa, ON, Canada. dmcisaac@toh.ca. 10. Departments of Anesthesiology & Pain Medicine, The Ottawa Hospital, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada. dmcisaac@toh.ca.
Abstract
BACKGROUND: Personalized medicine aims to improve outcomes through application of therapy directed by individualized risk profiles. Whether personalized risk assessment is routinely applied in practice is unclear; the impact of personalized preoperative risk prediction and communication on outcomes has not been synthesized. Our objective was to perform a scoping review to examine the extent, range, and nature of studies where personalized risk was evaluated preoperatively and communicated to the patient and/or healthcare professional. METHODS: A systematic search was developed, peer-reviewed, and applied to Embase, Medline, CINAHL, and Cochrane databases to identify studies of individuals having or considering surgery, where a process to assess personalized risk was applied and where these estimates were communicated to a patient and/or healthcare professional. All stages of the review were completed in duplicate. We narratively synthesized and described identified themes. RESULTS: We identified 796 studies; 24 underwent full-text review. Seven studies were included; one communicated personalized risk to patients, four to a healthcare professional, and two to both. Cardiac (n = 2) and orthopedic surgery (n = 2) were the most common surgical specialties. Four studies used electronic risk calculators, and three used paper-based tools. Personalized preoperative risk assessment and communication may improve accuracy of information provided to patients, improve consent processes, and influence length of stay. Methodologic weaknesses in study design were common. CONCLUSIONS: Personalized preoperative risk assessment and communication may improve patient and system outcomes. This evidence is limited, however, by weaknesses in study design. Appropriately powered, low risk of bias evaluation of personalized risk communication before surgery is needed.
BACKGROUND: Personalized medicine aims to improve outcomes through application of therapy directed by individualized risk profiles. Whether personalized risk assessment is routinely applied in practice is unclear; the impact of personalized preoperative risk prediction and communication on outcomes has not been synthesized. Our objective was to perform a scoping review to examine the extent, range, and nature of studies where personalized risk was evaluated preoperatively and communicated to the patient and/or healthcare professional. METHODS: A systematic search was developed, peer-reviewed, and applied to Embase, Medline, CINAHL, and Cochrane databases to identify studies of individuals having or considering surgery, where a process to assess personalized risk was applied and where these estimates were communicated to a patient and/or healthcare professional. All stages of the review were completed in duplicate. We narratively synthesized and described identified themes. RESULTS: We identified 796 studies; 24 underwent full-text review. Seven studies were included; one communicated personalized risk to patients, four to a healthcare professional, and two to both. Cardiac (n = 2) and orthopedic surgery (n = 2) were the most common surgical specialties. Four studies used electronic risk calculators, and three used paper-based tools. Personalized preoperative risk assessment and communication may improve accuracy of information provided to patients, improve consent processes, and influence length of stay. Methodologic weaknesses in study design were common. CONCLUSIONS: Personalized preoperative risk assessment and communication may improve patient and system outcomes. This evidence is limited, however, by weaknesses in study design. Appropriately powered, low risk of bias evaluation of personalized risk communication before surgery is needed.
Authors: Neel P Chudgar; Shi Yan; Meier Hsu; Kay See Tan; Katherine D Gray; Tamar Nobel; Daniela Molena; Smita Sihag; Matthew Bott; David R Jones; Valerie W Rusch; Gaetano Rocco; James M Isbell Journal: Ann Thorac Surg Date: 2020-10-17 Impact factor: 5.102
Authors: Michael D Wood; Kim Correa; Peijia Ding; Rama Sreepada; Kent C Loftsgard; Isabel Jordan; Nicholas C West; Simon D Whyte; Elodie Portales-Casamar; Matthias Görges Journal: JMIR Pediatr Parent Date: 2022-07-15
Authors: Ruben D Vromans; Saar Hommes; Felix J Clouth; Deborah N N Lo-Fo-Wong; Xander A A M Verbeek; Lonneke van de Poll-Franse; Steffen Pauws; Emiel Krahmer Journal: BMC Med Inform Decis Mak Date: 2022-10-05 Impact factor: 3.298