Impact of patient-centred education
versus standard education on adult anxiety levels
in the perioperative period:
A critical literature review using systematic methods
Major project towards the award of Master of Science
Thanks to my family, colleagues, mentors and friends who have supported me during this course. Without their support, guidance, patience and encouragement, this master’s degree would not have been possible. The invaluable support and guidance from librarians are much appreciated, both at the university and hospital, their expertise, has helped in making this journey smoother. It cannot go unmentioned the encouragement and guidance I have received from my hospitals mentors and colleagues. I am eternally grateful for your help, support during the duration of this course.
PCA Patient-centered approach
PCC Patient centered care
IC Individualized care
SR Systematic Review
HADS Hospital Anxiety and Depression Scale
STAI State Trait Anxiety Inventory
VAS Visual analogue scale
APAIS Amsterdam Preoperative Anxiety Information Scale
SDM Shared decision making
GA General Anaesthesia
SA Spinal Anaesthesia
RCT Randomised Control Trail
General Anaesthetic A loss of sensation or consciousness induced by intravenous drugs or inhaled gases
Spinal Anaesthesia or An injection into the subarachnoid space near the spinal cord
Spinal Block
Major surgery An invasive procedure requiring extensive resection of the body requiring a GA
Intermediate surgery A minimal invasive procedure requiring a small open incision or laparoscopically or arthroscopically requiring SA or GA
Heterogeneity Refers to SR differences of variables in the study
AIM
To investigate the impact of patient-centred education (PCE) on anxiety level in adult elective surgical patients during the perioperative periods.
BACKGROUND
Preoperative anxiety is known to have a major impact on the patients’ quality of life and outcome. Anxious patients have a high incidence of mortality and morbidity. Anxious patients often have higher blood pressure, heart rate and release cortisol, a corticosteroid hormone that can impede wound healing and prolong hospital discharge. Whilst, patient education is shown to be beneficial in reducing anxiety during the perioperative periods; effective strategy remains debatable. Too much or too little information can lead to anxiety. Recent research and government strategy has shown linked benefit of patient-centered approach to empowerment, shared-decision making (SDM) and better quality of life, leading to better outcome. Gaps in research suggest more research is needed to show linked benefits of promoting quality perioperative PCE on outcomes.
METHODS
A systematic literature search of EMBASE, CINAHL and MEDLINE databases was undertaken using relevant keywords. Studies dating from 2011 – 2021. Participants were adult in English language, focusing on patient-centred education. With comparisons of PCE versus standard education, with anxiety as a primary outcome prior to surgery. Eight studies were identified, evaluated and critically analysed.
RESULTS
In total 1646 participants in this SR. Preoperative education incorporating Patient centred care (PCC) and multimedia information are deemed effective strategies in reducing anxiety to promote quality outcome with 95% Confidence Interval (CI). There is limited research linking the benefits of PCE to reduce anxiety during the perioperative phase.
CONCLUSION
The most effective approach to PE remains inconclusive. However, evidence suggests incorporating a patient Centred Approach (PCA) in a combined standard education with multimedia information is a more effective strategy in reducing anxiety to promote quality outcomes.
Recommendation is more research is required, focusing on PCE, along with the benefit of the advance or specialist practitioner’s as educators in reducing perioperative anxiety to improve quality outcome.
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