March 2017 VOL 8, NO 3
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International Association for the Study of Lung Cancer
Preoperative Thoracic Surgery Education Improves Patient Outcomes
Preoperative thoracic surgery education increases patient satisfaction and decreases patient anxiety and readmission rates associated with postoperative complications, all while optimizing overall outcomes for thoracic surgery patients, according to Katherine O. Kuhns, CRNP, a nurse practitioner specialist in thoracic surgery at the University of Pennsylvania Penn Presbyterian Medical Center.
Lung cancer is the most common cancer worldwide, contributing to 13% of the total number of new cases diagnosed in 2012. Most lung cancer is found at a late stage when patients are not typically candidates for surgery, but even in those with earlier-stage lung cancer, 5-year survival is only 53.5%.
According to Ms Kuhns, patients undergoing thoracic surgery usually have little knowledge of what to expect during the preoperative, postoperative, and recovery periods. During the initial surgical visit for a known lung cancer or suspicious nodule, the patients will talk with the surgeon about their options, but a finite amount of time is allowed for preoperative teaching. “During this first surgical visit, patients are overwhelmed and anxious, and this inhibits their ability to comprehend or retain any information that you give them,” said Ms Kuhns at the International Association for the Study of Lung Cancer 17th World Conference on Lung Cancer. But multiple studies have shown that preoperative patient education can alleviate some of that anxiety while decreasing patient readmission rates following surgery.
Although the benefit of preoperative education is widely recognized, providing the resources for efficient and effective teaching is a challenge. “No one is being paid to strictly do patient education,” she noted. “We just have to find time to do it in addition to our other jobs.”
Developing a Program
First, find any participants (inpatient and outpatient nurse practitioners, physical therapists, nutritionists, case workers, etc) interested in preoperative teaching, said Ms Kuhns. She recommends collaborating with nurses and advanced practice providers across the care continuum, because these members of the care team have the knowledge base and access to patients and their families that are needed to provide effective patient education. Volunteers can also be found in the form of previous patients, as many are willing to share their experiences to help others navigate the surgical experience.
Ms Kuhns said teaching goals should be identified during the patient’s initial visit, not only to provide them with information but also to help patients acquire the knowledge necessary to change their behaviors and promote better health (ie, smoking cessation, better nutrition, adoption of an exercise plan) or overcoming social, economic, physical, mental, or religious barriers. She suggests utilizing programs that already exist within institutions and building on them to save money, and encourages the use of free web-based print and video teaching materials.
The Teaching Materials
She and her colleagues at the University of Pennsylvania designed a Preoperative Patient’s Guide to Thoracic Surgery booklet. After observing the need for additional education, they developed a Patient’s Guide to Thoracic Surgery video that includes preoperative teaching in addition to information on what to expect after surgery and discharge. “It’s full of really straightforward information for patients,” she said.
Both the booklet and the video are distributed to patients at their initial surgical visit; major points of the teaching materials are reviewed, and teaching goals are determined at this time. Patients are instructed to read through the information and watch the video at their convenience, and to call the office to discuss what they have learned and ask any questions they might have.
After the initial visit, the nurse calls or meets with the patient to go over the preoperative teaching materials, to review any study results, to answer questions, and to receive an update on the patient’s preoperative goals. “These conversations are documented in patients’ charts so that everyone is aware of how they’re progressing,” she added.
Ms Kuhns pointed out that after a patient has thoracic surgery, he or she becomes a captive audience in the hospital. She urges providers to remember this and to take advantage of these teaching moments. “Everyone can help promote healthier living,” she said. At her institution they also implemented a day-after-discharge phone call to make sure patients follow their discharge instructions correctly.
Results of a survey distributed to patients postoperatively showed that 50 of 56 patients who underwent thoracic surgery over a 4-month period were given the Thoracic Video Satisfaction Survey. Of the 42 patients who watched the video, survey results were overwhelmingly positive, she reported.
Preliminary results have shown that since the implementation of the thoracic teaching video in conjunction with the written material, there has been an increase in patient satisfaction and a decrease in anxiety associated with thoracic surgery, she said. Readmission and emergency department visits have also decreased.
According to Ms Kuhns, providing patients with multiformat educational materials and giving them the ability to review them on their own time have proven successful in her institution. “Patient education isn’t just about giving information,” she said. “It’s given in hopes that patients will have better experiences and change some of the behaviors we know need to be changed.”
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