Emily Hladkowicz1,2,3, David Yachnin1,3, Laura Boland3,4, Kumanan Wilson3,5, Annette McKinnon6, Kira Hawrysh6, Terry Hawrysh6, Cameron Bell3, Katherine Atkinson7, Carl van Walraven3,5,8, Monica Taljaard3,8, Kednapa Thavorn3,8, Dawn Stacey3,9, Homer Yang10, Christopher Pysyk1,3,11, Husein Moloo3,12, Doug Manuel3,8, David MacDonald13, Luke T Lavallée3,12, Sylvain Gagne1,11, Alan J Forster3,5,8, Gregory L Bryson1,3,11, Daniel I McIsaac14,15,16,17. 1. Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. 2. School of Rehabilitation Therapy, Queens' University, Kingston, ON, Canada. 3. Ottawa Hospital Research Institute, Ottawa, ON, Canada. 4. School of Health Studies, Western University, London, ON, Canada. 5. Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada. 6. The Ottawa Hospital, Ottawa, ON, Canada. 7. Department of Public Health Science, Karolinska Institute, Solna, Sweden. 8. School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. 9. School of Nursing, University of Ottawa, Ottawa, ON, Canada. 10. Department of Anesthesia and Perioperative Medicine, Western University, London, ON, Canada. 11. Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada. 12. Departments of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada. 13. Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada. 14. Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. dmcisaac@toh.on.ca. 15. Ottawa Hospital Research Institute, Ottawa, ON, Canada. dmcisaac@toh.on.ca. 16. School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. dmcisaac@toh.on.ca. 17. Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada. dmcisaac@toh.on.ca.
Abstract
PURPOSE: Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk communication tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care. METHODS: We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application's materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability. RESULTS: We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (- 1.9%; 95% CI, - 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists. CONCLUSION: Exposure to a patient-facing, personalized risk communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.
PURPOSE: Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk communication tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care. METHODS: We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application's materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability. RESULTS: We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (- 1.9%; 95% CI, - 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists. CONCLUSION: Exposure to a patient-facing, personalized risk communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.
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