Poor Patient Understanding of Expectations in Peripheral Nerve Surgery is Ameliorated by Written Surgical Educational Media
Brandon W Smith, MD, MS; Shawn Brown, CMA; Kate Wan-Chu Chang, MA, MS; Lynda Yang, MD, PHD; University of Michigan, Ann Arbor, MI
Introduction: Realistic expectations from peripheral nerve surgery are critical for patient satisfaction. Unrealistic expectations reduce patient satisfaction given the limitations of our procedures. Despite verbal preoperative education, most clinicians can recall instances where the patients expressed unrealistic expectations. We evaluated the impact of a written educational handout on patient expectations after peripheral nerve surgery.
Methods: We recruited patients scheduled to undergo peripheral nerve surgery at a single institution from 2016-2017. During the pre-operative visit, a specialized nurse practitioner reviewed perioperative protocols, risk and benefits of the surgery, and post-operative care. Patients immediately completed a survey to assess their pre-operative understanding of the verbally reviewed information; during the same visit, an additional written handout (containing the reviewed information including expected pain, motor and sensory function recovery) was given to patients in a randomized fashion. At their first post-operative visit, all patients completed the same survey. We applied standard statistical methods to compare (1) the error rate between the with and without written handout groups and (2) the effectiveness of the written handout.
Results: Thirty-nine patients (mean age of 52 years) participated, and 64% were men. Despite immediately preceding verbal instruction, 31% of patients had erroneous (unrealistic) expectations regarding pain. At the post-operative visit, the group that received the written handout reported a 14% more appropriate understanding regarding pain than the group without the handout. For understanding of the expected recovery of motor function, 32% answered incorrectly at the pre-operative visit. Specifically regarding handout effectiveness for pain, in those individual patients who answered the question incorrectly at the pre-operative visit (N=12), 71% of those with the handout (N=5/7) answered correctly at the post-operative visit compared to 40% without the handout (N=2/5). The handout also showed effectiveness in educating patients regarding motor function recovery expectations (38%, 3/8 with versus 25%, 1/4 without the written handout).
Conclusions: Patients undergoing peripheral nerve procedures demonstrate a high baseline level of misunderstanding of postoperative expectations despite standard in-person verbal counseling. This misunderstanding causes significant difficulties for the surgeon to meet surgical expectations, thereby reducing patient satisfaction. We demonstrated that a simple written handout, reiterating surgical expectations, increased patient understanding significantly. Further investigation is needed to evaluate the effect of the handout on patient satisfaction.
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