Évaluation d’un outil de communication du risque préopératoire personnalisé : une étude prospective avant-après

Emily Hladkowicz; David Yachnin; Laura Boland; Kumanan Wilson; Annette McKinnon; Kira Hawrysh; Terry Hawrysh; Cameron Bell; Katherine Atkinson; Carl van Walraven; Monica Taljaard; Kednapa Thavorn; Dawn Stacey; Homer Yang; Christopher Pysyk; Husein Moloo; Doug Manuel; David MacDonald; Luke T. Lavallée; Sylvain Gagne; Alan J. Forster; Gregory L. Bryson; Daniel I. McIsaac

doi:10.1007/s12630-020-01809-y

Évaluation d’un outil de communication du risque préopératoire personnalisé : une étude prospective avant-après

Translated title of the contribution: Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study

Emily Hladkowicz, David Yachnin, Laura Boland, Kumanan Wilson, Annette McKinnon, Kira Hawrysh, Terry Hawrysh, Cameron Bell, Katherine Atkinson, Carl van Walraven, Monica Taljaard, Kednapa Thavorn, Dawn Stacey, Homer Yang, Christopher Pysyk, Husein Moloo, Doug Manuel, David MacDonald, Luke T. Lavallée, Sylvain GagneAlan J. Forster, Gregory L. Bryson, Daniel I. McIsaac

Medicine

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

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.

Translated title of the contribution	Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study
Original language	French
Pages (from-to)	1749-1760
Number of pages	12
Journal	Canadian Journal of Anaesthesia
Volume	67
Issue number	12
DOIs	https://doi.org/10.1007/s12630-020-01809-y
Publication status	Published - Dec 2020

Bibliographical note

Funding Information:
The study was supported through peer-reviewed grants from The Ottawa Hospital Academic Medicine Organization and The Ottawa Hospital Department of Anesthesiology & Pain Medicine.

Funding Information:
Daniel I. McIsaac receives salary support from The Ottawa Hospital Department of Anesthesiology & Pain Medicine; Daniel I. McIsaac is supported by the Canadian Anesthesiologists’ Society Career Scientist Award.

Publisher Copyright:
© 2020, Canadian Anesthesiologists' Society.

ASJC Scopus Subject Areas

Anesthesiology and Pain Medicine

Access to Document

10.1007/s12630-020-01809-y

Cite this

Hladkowicz, E., Yachnin, D., Boland, L., Wilson, K., McKinnon, A., Hawrysh, K., Hawrysh, T., Bell, C., Atkinson, K., van Walraven, C., Taljaard, M., Thavorn, K., Stacey, D., Yang, H., Pysyk, C., Moloo, H., Manuel, D., MacDonald, D., Lavallée, L. T., ... McIsaac, D. I. (2020). Évaluation d’un outil de communication du risque préopératoire personnalisé : une étude prospective avant-après. Canadian Journal of Anaesthesia, 67(12), 1749-1760. https://doi.org/10.1007/s12630-020-01809-y

Hladkowicz, E, Yachnin, D, Boland, L, Wilson, K, McKinnon, A, Hawrysh, K, Hawrysh, T, Bell, C, Atkinson, K, van Walraven, C, Taljaard, M, Thavorn, K, Stacey, D, Yang, H, Pysyk, C, Moloo, H, Manuel, D, MacDonald, D, Lavallée, LT, Gagne, S, Forster, AJ, Bryson, GL & McIsaac, DI 2020, 'Évaluation d’un outil de communication du risque préopératoire personnalisé : une étude prospective avant-après', Canadian Journal of Anaesthesia, vol. 67, no. 12, pp. 1749-1760. https://doi.org/10.1007/s12630-020-01809-y

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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{\textquoteright}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.",

author = "Emily Hladkowicz and David Yachnin and Laura Boland and Kumanan Wilson and Annette McKinnon and Kira Hawrysh and Terry Hawrysh and Cameron Bell and Katherine Atkinson and {van Walraven}, Carl and Monica Taljaard and Kednapa Thavorn and Dawn Stacey and Homer Yang and Christopher Pysyk and Husein Moloo and Doug Manuel and David MacDonald and Lavall{\'e}e, {Luke T.} and Sylvain Gagne and Forster, {Alan J.} and Bryson, {Gregory L.} and McIsaac, {Daniel I.}",

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T1 - Évaluation d’un outil de communication du risque préopératoire personnalisé

T2 - une étude prospective avant-après

AU - Hladkowicz, Emily

AU - Yachnin, David

AU - Boland, Laura

AU - Wilson, Kumanan

AU - McKinnon, Annette

AU - Hawrysh, Kira

AU - Hawrysh, Terry

AU - Bell, Cameron

AU - Atkinson, Katherine

AU - van Walraven, Carl

AU - Taljaard, Monica

AU - Thavorn, Kednapa

AU - Stacey, Dawn

AU - Yang, Homer

AU - Pysyk, Christopher

AU - Moloo, Husein

AU - Manuel, Doug

AU - MacDonald, David

AU - Lavallée, Luke T.

AU - Gagne, Sylvain

AU - Forster, Alan J.

AU - Bryson, Gregory L.

AU - McIsaac, Daniel I.

PY - 2020/12

Y1 - 2020/12

N2 - 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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