The primary aim of this project was to evaluate patients’ satisfaction with the information received during their operative experience and propose improvements. In general, patients were satisfied with the information and care they received. Some resources were found more useful than others and leaflets do not appear to meet the needs of the patient population anymore. Very few patients received or viewed webpages pertaining their procedure, but it was clear that many patients would value this. Exposing patients to other individuals who had undergone the same operation had a variable impact. Patients have reported that they want more specific and succinct information that applied to them and the procedure they are undertaking. Further information was requested on the topics of post-operative pain, recovery, the procedure and who would be in theatre with them.
Many patients requested more internet resources, specifically asking for webpages about their procedures, online recovery timelines and a method of leaving questions for the surgeons to respond to in due course. A previous study has demonstrated that online resources can improve both the knowledge of patients and satisfaction with their surgery but should not be used in place of interactions with healthcare providers . Another study suggested that all patients be directed to online resources, which would augment their knowledge and improve their informed status when consenting for procedures . This suggests it may be worth investing in electronic resources to engage patients more. Such resources could take the form of expert patient blogs or vlogs, as many of the participants requested a balanced one to one meeting with a patient who had undergone the same procedure. With considerations around the logistics of organising meetings, including cost, infection risk and patient safety, expert patient blogs or vlogs would provide a regulated and cost-effective method of hearing about others’ experiences, proven to work in medical education, without the added cost and administration associated with in-person meetings or the bias observed on social media currently [25, 26].
Additionally, although patients undergoing replacement operations received the most literature and support from physiotherapists, they were less satisfied than the HTO patients, who currently do not receive any leaflets (one is in development) or group sessions at all. This could be due to bias from the surgeons, who are more enthusiastic about these procedures and may spend more time explaining the process and outcomes of the operation, subsequently improving the patient’s perception of their care and ensuring more accurate post-operative expectations [13, 14].
The variability of the results demonstrates that patients have differing values, highlighting holistic and patient centred care is vital in surgery and that the WHO’s integrated care model is important . Resources must be of high quality, pitched at the right health literacy level and given to patients at the right time in their surgical experience to be of maximal benefit [27, 28]. The project also demonstrated that patients need different resources pre and post-operatively, reinforcing that tailored patient information, pain management and the use of other mediums such as social media and the internet may be useful in improving patients’ understanding of procedures and recovery [29, 30].
Common additional information requests were similar to other studies, and included post-operative activity levels, recovery, returning to work, how to cope at home and pain relief, including side effects [29, 31, 32]. A simple solution to this could be the development of a “Frequently Asked Questions” section on a website, whereby patients could seek out the answers to questions they have as they think of them.
Although the majority of current literature has not evaluated patient satisfaction of information, a previous study suggested that the NHS provide varied, conflicting and unstandardised literature to patients, concluding that patient involvement in the designing of resources is important . Additionally, key pieces of information about a patient’s recovery are often given directly after they have been aroused from anaesthesia . This poses problems as patients' memory function is impaired directly after surgery . By delaying information provision until right before the patient is discharged, or at least 40 min after waking up from anaesthetic, retention could be drastically improved . Better still, by giving out information packs in advance of procedures, surgeons could offer consolidated and pre-organised information for the patient to assimilate more easily and allow for a more informed decision making process.
Post-operative patients were statistically more likely to be dissatisfied with the information and care they had received, when compared to post-operative patients. Although there is no literature suggesting why this might be, it could be because patients are unsure what they want before their operations, or that we do not include what they would have found useful in the resources we give to them. Equally, most patients were questioned in the three to six-week window post-operatively, the period in which patients have the most pain without drastic functional benefit. A recurring theme throughout previous literature is the importance of engaging patients in the production of resources, but this is something rarely done in clinical practice . A review around this topic suggested that patients’ coping strategies differ and employing needs based information provision, where patients are asked what information they might like to receive prior to a consultation, would enhance satisfaction and reduce pre-surgical anxiety . An implication of this finding is that patients should actively be involved in designing materials for other patients, at least in the drafting phase. This should also be a continual evaluative process, whereby patients are asked to evaluate their functional outcomes as well information they received routinely. This could ultimately improve patient readiness, outcomes and satisfaction with the service provided.
Strengths & weaknesses
Strengths of this project included the addition of free-text answers in the questionnaire so patients could reflect on what they felt was important for us to know. The project also evaluated a range of surgeons, evaluating most of the service. Limitations include the sample population size being relatively small and not ensuring that all patients answered the same questions. Additionally, there was an unequal distribution of procedure types and ages, meaning some groups may be under- or over-represented, which limited the depth of analysis we could perform within subgroups. Post-operative patients were interviewed up to a year after their operation, meaning that some had forgotten about the specifics of their procedure, potentially enabling recall bias. Finally, the same patients were not interviewed before and after their procedures. This means that comparison between post and pre-operative patients should be interpreted with caution, although having a variety of patients allows more voices to be heard throughout the process. Moreover, using a thematic analysis is relatively subjective and although all effort was made to reduce bias, this is difficult to eradicate from a qualitative methods analysis.