Patient Recollection Research Articles

P13.08.A JAKOB V. E. GERSTL, MBBS

Abstract BACKGROUND Pituitary adenomas are benign neoplasms which can have a profound impact on quality of life. In-situ assessments of patient quality of life with pituitary adenomas and recovery from surgery are limited; existing patient reported outcome measures are, moreover, biased by patient recollection. Smartphone-based digital phenotyping may provide a means of monitoring patient recovery and quality of life at a more granular and accurate level. MATERIALS AND METHODS Patients with pituitary adenomas were enrolled during preoperative clinic visits. Included patients installed the Beiwe application, which passively collected GPS data during patient follow-up. Dates of significant clinical events were recorded to assess how they affected mobility. Using a LOESS regression line, aggregate trends amongst patients who underwent transsphenoidal resection were established and compared to baseline values from preoperative patients awaiting surgery and non-operative controls. RESULTS As part of a still ongoing study, 35 Patients with pituitary adenomas were enrolled between October 2022 and February 2023. Of these, 13 underwent transsphenoidal resection, the remaining 22 patients were either waiting for surgery and/or served as non-operative controls. Patients undergoing transsphenoidal resection of pituitary adenomas spent more time at home, spent less time walking, walked fewer steps and traveled shorter distances away from home compared following surgery compared to baseline preoperative data and non-operative controls. CONCLUSION The authors were able to generate initial digital phenotypes for a cohort of pituitary patients based on passively collected smartphone GPS data; the authors also hope that these initial data may help in the establishment of an in-situ tool to monitor recovery following surgery for pituitary adenoma. It is the authors’ contention that such preoperative mobility metrics may be further utilized to predict postoperative outcomes following surgery which has been demonstrated in the general surgery setting. In the case of pituitary disease, these include postoperative CSF leak, infection, dysnatremia and hospital length of stay.

Do Patients Accurately Recall Their Preoperative Symptoms After Elective Orthopedic Procedures?

Patient-reported outcome measures are a frequent tool used to assess orthopedic surgical outcomes. However, recall bias is a potential limitation of these tools when used retrospectively, as they rely on patients to accurately recall their preoperative symptoms. A database search of Cochrane Library, PubMed, Medline Ovid, and Scopus until May 2021 was completed in duplicate by two reviewers. Studies considered eligible for inclusion were those which reported on patient recall bias associated with orthopedic surgery. The primary outcome of interest investigated was the accuracy of patient recollection of preoperative health status. Any factors that were identified as affecting patient recall were secondary outcomes of interest. Of the 4,065 studies initially screened, 20 studies with 3,454 patients were included in the final analysis. Overall, there were 2,371 (69%) knee and hip patients, 422 (12%) shoulder patients, 370 (11%) spine patients, 208 (6%) other upper extremity patients, and 83 (2%) foot and ankle patients.Out of the eight studies that evaluated patient recall within three months postoperatively, seven studies concluded that patient recall is accurate. Out of the 13 studies that evaluated patient recall beyond three months postoperatively, nine studies concluded that patient recall is inaccurate. The accuracy of patient recall of preoperative symptoms after elective orthopedic procedures is not reliable beyond three months postoperatively.

44. Does recall bias exist in lumbar spine surgery patients as reported through PROMIS questionnaires?

<h3>BACKGROUND CONTEXT</h3> Surgical outcomes are increasingly judged on patients' perceptions of the results. Despite the improved quantitative data provided by patient-reported outcomes (PROs), they remain susceptible to confounding factors on patients' interpretations such as recall bias: the inability to accurately recall prior impairment. No studies to date have reported the accuracy of patient recall using PROMIS outcomes after lumbar spine surgeries. <h3>PURPOSE</h3> The purpose of this study is to determine the presence and extent of recall bias in adult patients after elective lumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> Subgroup analysis of ongoing prospective study. <h3>PATIENT SAMPLE</h3> This study included 98 patients who had undergone either lumbar decompression or lumbar decompression and fusion procedures. <h3>OUTCOME MEASURES</h3> Baseline preoperative PROMIS Physical Function (PF), PROMIS Pain Interference (PI) and recalled preoperative PROMIS PF and PI. <h3>METHODS</h3> Patients, at least 2 years after their index surgery, completed a recall questionnaire comprised of the PF CAT and PI CAT as though it was a time immediately before their surgery. All patients had prospectively completed PROMIS PF CAT and PI CAT prior to surgery and at 3 months, 6 months, 1 year and 2 years. T tests were used to compare recalled PROs with actual baseline PROs. Correlation coefficients were calculated to evaluate the agreement between recalled PROs and baseline PROs. Regression analysis was performed to determine the impact of patient characteristics or clinical factors. <h3>RESULTS</h3> Patient recollection of preoperative status at a minimum of 2 years postoperatively was significantly more severe than baseline preoperative status with mean difference in PF of -1.5 (p < 0.05) and PI of 2.1 (p < 0.01). There was only moderate correlation between recalled and baseline scores with regards to PF (r=0.52) and PI (r=0.38). No significant differences on recalled PROs were found based on age, gender, time between surgery and recalled outcomes, and duration of symptoms before surgery. <h3>CONCLUSIONS</h3> Our data indicate that patient recall of preoperative status after lumbar surgery is significantly different than actual baseline preoperative status as measured by PROMIS PF and PI scores with only moderate correlation existing between the two. Patients' interpretations of improvement after surgery may be impacted by significant recall bias. This may have an impact on patient satisfaction and perceived value of lumbar spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Didn't put a label on it: Examining intimate partner strangulation within a diagnostic framework.

The aim was to examine and describe women's emergency department visits and care-seeking experiences, including recognition, evaluation and communication of symptoms, injuries and health risks after non-fatal intimate partner strangulation. Using a diagnostic process framework, this mixed-methods study explores concordance and discordance of interview and medical records data to highlight opportunities for clinical diagnostic improvement. In-depth, semi-structured interviews with women after an emergency department visit for non-fatal intimate partner strangulation, concurrent with medical records reviews, were conducted between March 2018 and January 2019. A constant comparative approach was used to analyse interview and medical record data using an a priori codebook designed based on the National Academies of Science, Engineering and Medicine's conceptual model of the diagnostic process and prior intimate partner violence research. Interviews reflected participants did not have a sense of long-term health risks from their strangulation beyond addressing emotional trauma. Women noted that forensic and emergency nursing support was treatment in and of itself that allowed them to be heard and validated. Medical record clinical impressions and final diagnoses included domestic violence, domestic abuse or sexual assault, but not specifically strangulation. This study contributes to the growing literature regarding strangulation diagnosis and care. Our findings provide new details of women's emergency department care-seeking experiences which, whilst overall aligned with medical records documentation, were not reflected in final diagnostic impressions nor in patient recollection of long-term health risks. Nurses are strongly positioned as clinical practice leaders and policy advocates to improve collective responses to this dangerous violence mechanism. Actions such as improving patient education, referral and follow-up options to better communication and address long-term strangulation risk are one example. Further research on non-fatal intimate partner strangulation and care-seeking is warranted to expand this knowledge, particularly in longitudinal cohorts and varied geographical areas.

SF-36 physical function and general health domains are independent predictors of acute hospital length of stay after hip fracture surgery.

The demographics and co-morbidities of individuals may impact healthcare consumption, but it is less understood how premorbid physical and mental function may influence these effects. The aim of this study is to determine patient's pre-fracture quality of life and mobility affect acute hospital burden in the management of hip fracture, using length of stay (LOS) as a proxy for healthcare resource. This is a retrospective study which investigated hip fracture patients who underwent surgery over the period of 2017-2020. Variables collected include LOS, age, gender, race, marital status, payer type, ASA score, time to surgery (TTS), type of surgery, fracture type, POD1 mobilization, discharge disposition, pre-fracture SF-36, EQ-5D and Parker mobility score (PMS) based on patient's recollection on admission. These variables were correlated with LOS using binary logistic regression on SAS. There were 1045 patients, and mean age was 79.5 + 8.57 (range 60-105) years with an average LOS 13.64 + 10.0days (range 2-114). On univariate analysis, PMS, EQ-5D and all domains of SF-36 except bodily pain (BP), emotional role and mental health were associated significantly with LOS. Amongst the QOL and PMS scores, only the domains of SF-36 Physical Function (PF) (OR = 0.993, p = 0.0068) and General Health perception (GH) (OR 0.992, p = 0.0230) remained significant on the multivariate model. Our study showed that poor premorbid scores of SF36 PF and GH are independent factors associated with longer LOS in hip fracture patients after surgery, regardless of fracture type, age and ASA status. Hence, premorbid SF36 PF and GH can be used to identify patients that are at risk of prolonged hospital stay and employ targeted strategies to facilitate rehabilitation and discharge planning.

Incongruence between Physician, Patient, and Medical Chart Report of Skin Cancer Prevention Counseling.

Skin cancer incidence in the United States has risen rapidly in recent decades, underscoring the need for accessible and effective prevention practices. Skin cancer prevention counseling can lead to increased sun protective behavior and early detection; however, little is understood regarding the frequency and content of counseling among primary care providers (PCPs). We performed multi-center cross-sectional surveys among 53 providers and 3343 of their patients and chart review asking whether skin cancer prevention counseling occurred and details of that counseling. Only 10–25% of patients reported that counseling occurred. Among the providers who reported counseling, there were higher odds that their patients recollected they were advised to use sunscreen or protective clothing, on how to use sunscreen, on signs of skin cancer, to perform a self-skin exam (all p < 0.001), and were provided with written materials (p < 0.01). Eight percent of prevention counseling was chart documented despite being highly associated with patient and physician recollection of counseling (p < 0.001). These results highlight the need for consistent and clear delivery of skin cancer primary prevention.

A Woman With a Surgical Site Infection.

Dr. Kalen N. Wright: Today's case is that of a 46-year-old woman who presented to the emergency department (ED) for evaluation of a surgical site infection (SSI). She reported that 1 month prior she underwent abdominoplasty, liposuction, and bilateral buttock augmentation at a plastic surgery clinic located in the Dominican Republic (DR). Medical records from the clinic were not available and so the history was obtained from the patient's recollection of events. She reported clinic re-evaluation 3 days postoperatively for surgical site bleeding and was diagnosed with anemia.

Confirming a Historical Diagnosis of Multiple Sclerosis: Challenges and Recommendations.

Patients with a historical diagnosis of multiple sclerosis (MS)-a patient presenting with a diagnosis of MS made previously and by a different clinician-present specific diagnostic and therapeutic challenges in clinical practice. Application of the McDonald criteria is most straightforward when applied contemporaneously with a syndrome typical of an MS attack or relapse; however, retrospective application of the criteria in some patients with a historical diagnosis of MS can be problematic. Limited patient recollection of symptoms and evolution of neurologic examination and MRI findings complicate confirmation of an earlier MS diagnosis and assessment of subsequent disease activity or clinical progression. Adequate records for review of prior clinical examinations, laboratory results, and/or MRI scans obtained at the time of diagnosis or during ensuing care may be inadequate or unavailable. This article provides recommendations for a clinical approach to the evaluation of patients with a historical diagnosis of MS to aid diagnostic confirmation, avoid misdiagnosis, and inform therapeutic decision making.

P55. Do patients accurately recall symptoms pre and post lumbar epidural steroid injection: A cohort study of recall bias in patient reported outcomes

<h3>BACKGROUND CONTEXT</h3> Although patient-reported outcomes (PROs) have become important in the evaluation of spine surgery patients, the accuracy of patient recall of pre or post-intervention symptoms following epidural steroid injection remains unknown. <h3>PURPOSE</h3> The purpose of this study was 1) to characterize the accuracy of patient recollection of back/leg pain following epidural steroid injection; 2) characterize the direction and magnitude of recall bias; 3) characterize factors that impact patient recollection. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort study. <h3>PATIENT SAMPLE</h3> Consecutive patients 18 years and older undergoing lumbar epidural steroid injection presenting with neurogenic claudication or radiculopathy secondary to degenerative lumbar spinal stenosis <h3>OUTCOME MEASURES</h3> Numeric pain scale (NPS) for back pain and leg pain. <h3>METHODS</h3> Using standardized questionnaires, we recorded numeric pain scores (NPS) for patients undergoing lumbar epidural steroid injections at our institution. Baseline pain scores were obtained prior to injection, 4 hours and 24-hours post-injection. At a minimum of 2 weeks following the injection, patients were asked to recall their symptoms pre-injection and at 4 hours and 24-hours post-injection. Actual and recalled scores at each time point were compared using paired t-tests. Multivariable linear regression was used to identify factors that impacted recollection. <h3>RESULTS</h3> Sixty-one patients with a mean age of 61.4 years (56% female) were included. Compared to their pre-injection pain score, patients showed considerable improvement at both 4 hours [Mean Difference (MD) = 2.18, 95% Confidence Interval (CI) 1.42 to 2.94)) and 24 hours (MD = 2.64, 95% CI 1.91 to 3.34) post-injection. Patient recollection of pre-injection symptoms was significantly more severe than actual (MD = 1.39, 95% CI 4.82 to 6.08). The magnitude of recall bias was moderate to severe and exceeded the minimal clinically important difference (MCID). Patient recollection of symptoms was also significantly more severe than actual at 24 hours (MD = 0.63, 95% CI -1.17 to -0.07), mild magnitude of bias that did not exceed MCID. No significant recall bias was noted on patient recollection of post-injection symptoms at 4 hours (MD = 0.41, 95% CI -1.05 to 0.23). Linear regression models for differences between actual and recalled pain scores reveal that for recall at 4 hours post-injection, older patients were better at recalling pain. <h3>CONCLUSIONS</h3> Relying on patient recollection does not provide an accurate measure of pre-injection status after lumbar epidural steroid injection, although patients did recall their 4 hour and 24-hour post-injection status. These findings support previous studies indicating that relying on patient recollection does not provide an accurate measure of pre-intervention symptoms. Patient recollection of post-intervention symptoms, however, may have some clinical utility and requires further study. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Critically ill patients' experience of agitation: A qualitative meta‐synthesis

Acute episodes of agitation are frequently experienced by patients during critical illness, yet what is not understood is the experience of agitation from the patient and family perspectives. To search existing literature, appraise it and then provide a synthesized interpretation to broaden the understanding of patients' and their families' experience of agitation during an adult critical care admission. Qualitative meta-synthesis. A qualitative meta-synthesis based on a systematic literature search registered with PROSPERO. The search conducted between July and September 2019 was applied to ProQuest, Cumulative Index to Nursing and Allied Health, British Nursing Index, Cochrane Library, Ovid Medline, Web of Science, and PsycINFO databases. We appraised the selected literature and presented a synthesized interpretation. Analysis was based on the approach of Gadamerian hermeneutics. Due to the lack of data identified; the family experiences of agitation could not be addressed within the review. In total, 8 studies were included capturing the experiences of 494 patients, aged between 18 and 92 years, with 225 (45%) women. The analysis generated three core themes: (a) What is real, what is not, (b) loss of communication and dependency, and (c) what helps, what does not. Fear of death, the emotion of anxiety, and feelings of pain alongside transient periods of fluctuating conscious levels provoked a feeling of intense vulnerability. The loss of effective communication and the feeling of dependence incite agitation and distress. The patient's recollection of their critical illness can be completely or partially absent and disjointed with uncertainty around what is real and what is not. Family members observe the full effect of the patient's critical care illness and could be a wealth of untapped information. Increasing awareness of the critically ill patients' experience of agitation highlights possible contributing factors to agitation development, such as staff interaction and communication skills, and the critical care environment.

Creation and Implementation of the UCSF Laryngeal Symptom Diary for Trial Vocal Fold Injection

Patient recollection of their trial vocal fold injection outcomes is crucial in determining future treatment. This study aims to assess a new clinical tool, the UCSF Laryngeal Symptom Diary, for its ease of use, clinical value in patient symptom tracking, and utility for long-term decision-making following trial vocal fold injection. In this prospective cohort study, consecutive patients undergoing trial vocal fold injection between June 2019 and January 2020 completed the UCSF Laryngeal Symptom Diary. Patients rated standardized and customized laryngeal symptoms weekly. Upon follow-up, a survey pertaining to the diary was completed by both the patient and treating laryngologist. A total of 29 patients opted to participate and were provided with the UCSF Laryngeal Symptom Diary. The diary was returned by 82.3% (n=24/29) of patients. Mean time to follow up was 5.98 weeks. Survey participation rate was 93.1% (n=27/29). From the patients' perspective, 66.7% (n=18/27) found the diary useful in following their symptom evolution. Treating laryngeal surgeon noted excellent concordance between diary entries and patient's overall injection benefit (91.7%, n=22/24). The diary was useful in clinician-recommendation of subsequent treatment options in 70.8% (n=17/24) of patients. The UCSF Laryngeal Symptom Diary is a patient friendly clinical tool for trial vocal fold injection that facilitates patient tracking of symptom evolution and helps guide treating clinicians in subsequent treatment planning.

A cross-sectional investigation of communication in Do-Not-Resuscitate orders in Dutch hospitals

BackgroundThe decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives. AimTo determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding. MethodsThis was a two-week nationwide multicentre cross-sectional observational study using a study-specific survey. The study population consisted of patients admitted to non-monitored wards in 13 hospitals. Data were collected from the electronic medical record (EMR) concerning CPR-directive, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire. ResultsA total of 1136 patients completed the questionnaire. Patients’ CPR-directives were documented in the EMR as follows: 63.7% full code, 27.5% DNR and in 8.8% no directive was documented. DNR was most often documented for patients >80 years (66.4%) and in patients using >10 medications (45.3%). Overall, 55.8% of patients recalled having had a conversation about their CPR-directive and 48.1% patients reported the same CPR-directive as the EMR. Most patients had a good experience with the CPR-directive conversation in general (66.1%), as well as its timing (84%) and location (94%) specifically. ConclusionsThe average DNR-prevalence is 27.5%. Correct understanding of their CPR-directive is lowest in patients aged ≥80 years and multimorbid patients. CPR-directive counselling should focus more on patient involvement and their correct understanding.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in pregnancy: a case series of nine patients and review of literature

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy characterized by myocardial necrosis and fibrofatty substitution of the myocardium, predominantly of the right ventricle. The evaluation of risk associated with gestation and delivery in patients with ARVC is difficult due to the small number of already reported cases. We present our experience of patients with ARVC who completed a pregnancy and delivery. Methods A case series of nine women in Calgary, Canada, from 2013 to 2018, who were diagnosed with ARVC before or during pregnancy. Patients were identified using our Cardiac-Obstetrics database, and information was collected through electronic charts and patient recollection. Results All pregnancies reported were singleton with an average maternal age of 31 years. Six patients had a related genetic mutation. Beta blockers were being used by eight, and five had an implantable cardioverter-defibrillator (ICD) prior to the pregnancy. None of the patients developed heart failure during pregnancy, but one had a complicated antepartum and postpartum course. All pregnancies delivered at term with eight receiving neuroaxial analgesia. Five patients delivered vaginally. Those without an ICD had continuous cardiac monitoring intrapartum. The incidence of small for gestational age (33%) was higher than the general population. All of the patients breastfed the newborns. Conclusions Pregnancies in these patients with ARVC were generally well tolerated. Given the rarity of the disease and absence of any clinical guidelines, multidisciplinary care is essential in the management of these patients.

"Uninformed" Consent: Patient Recollection From Surgical Consent in Hand Surgery-A Quality Improvement Initiative.

Background: Informed surgical consent is necessary and routine; however, it can have significant inadequacies. Our purpose was to investigate patient recollection of the surgical consent process and evaluate adequacy from the patient's perspective. Methods: A quality improvement framework was used. Two patient surveys capturing information recall and satisfaction of the consent process were administered in 5 consecutive hand clinics. All patients who previously underwent elective hand surgery were included. Results: There was exceptionally low recall of the risks and benefits of surgery in 103 consecutive patients who underwent hand surgery. Patients under age 35 had slightly better recall of surgical risks. Unexpected postoperative events affected patient perceptions of the consent process. Conclusions: Patients who have undergone elective hand surgery have poor recollection of the information discussed during the surgical consent process, and therefore the process is lacking. Surgeons may falsely assume that the consent process is sound because it is erroneously perceived as being sufficient by most patients.

The differences between patient and optometrist experiences of contact lens hygiene education from the perspective of a Scottish university teaching hospital

BackgroundContact lens related keratitis is a frequent presentation to acute ophthalmology services. Patients often do not recall being counselled regarding the safe use of contact lenses therefore fail to comply with guidance.This study aimed to identify the content and format of advice given to patients with contact lens keratitis concerning appropriate hygiene practices, determine their compliance with this and finally characterise optometrist practices regarding contact lens advice provided to patients. MethodsAll adult patients presenting with contact lens related keratitis to the acute ophthalmology clinic were asked to complete a survey. Information was collected on lens type, format of advice received and compliance.Community optometrists were asked to complete an electronic survey on their contact lens review practices and routine patient education. ResultsAll patients surveyed recalled counselling on initiation of contact lenses; however 12% (6/50) were given no advice on return visits. This advice was in written format for 20% (10/50) of patients on initiation increasing to 32% (16/50) on renewal.Many patients slept (22%), showered (44%) or swam (36%) in lenses. 92% cleaned their contact lenses appropriately, but cases were washed infrequently (19% of cases cleaned < monthly) or with tap water (27%).All optometrists surveyed claimed to provide advice to patients in either written or verbal format for new and returning contact lens users. 49% (16/33) of optometrists gave written advice to patients on initial contact lens fitting, but only 1/33 continued with written advice for repeat customers. ConclusionThis study identified that although most patients were informed of appropriate hygiene requirements, compliance was poor. Optometrists regularly provide verbal advice but do not routinely offer written support and there is a mismatch between patient recollection and self-reported optometrist practice. It is suggested that patient education needs greater emphasis and both verbal and written information should be regularly provided on initial review and follow up assessments.

Do Cervical Spine Surgery Patients Recall Their Preoperative Status?: A Cohort Study of Recall Bias in Patient-reported Outcomes.

This is a prospective cohort study. To characterize the accuracy of patient recollection of preoperative symptoms after cervical spine surgery. Recall bias is a well-known source of systematic error. The accuracy of patient recall after cervical spine surgery remains unknown. Consecutive patients undergoing cervical spine surgery for myelopathy or radiculopathy were enrolled. Neck and arm numeric pain scores and Neck Disability Indices were recorded preoperatively. Patients were asked to recall their preoperative status at either short (<1 y) or long-term (≥1 y) follow-up. Actual and recalled scores were compared using paired t tests and relations were quantified using the Pearson correlation coefficients. Multivariable linear regression was used to identify factors impacting recollection. In total, 73 patients with a mean age of 58.2 years were included. Compared with their preoperative scores, patients showed significant improvement in neck pain [mean difference (MD)=-2.9; 95% confidence intervals (CIs), -3.5 to -2.3], arm pain (MD, -3.4; 95% CI, -4.0 to -2.8), and disability (MD, -12.4%; 95% CI, -16.9 to -7.9). Patient recollection of preoperative status was significantly more severe than actual for neck pain (MD, +1.5; 95% CI, 0.8-2.2), arm pain (MD, +2.3; 95% CI, 1.6-3.0), and disability (MD, +5.8%; 95% CI, 2.4-9.2). Moderate correlation between actual and recalled scores with regard to neck (r=0.41), arm (r=0.50) pain, and disability (r=0.67) was seen. This was maintained across age, sex, and time between date of surgery and recollection. Over 30% of patients switched their predominant symptom from neck-to-arm pain or vice versa on recall of their preoperative symptoms. Relying on patient recollection does not provide an accurate measure of preoperative status after cervical spine surgery. Prospective and not retrospective collection of patient-reported outcomes remain the gold standard to measure and interpret outcomes after cervical spine surgery. Recall bias has the potential to affect patient satisfaction and requires further study.

Discordance of patient and provider perceptions of the meaning of verbal estimates of perioperative risk

PurposeTo determine whether the use of semiquantitative, verbal (non-numerical) language to express levels of perioperative risk is a possible cause of poor communication between practitioners and patients. MethodsSurvey forms were distributed to patients who had just completed an outpatient preoperative clinic visit at a large academic medical center. Surveys were distributed from October 2015 through March 2016. Data collected included demographic characteristics, literacy and numeracy characteristics, patient recollection of level of risk discussion, and the effect of the discussion on patient desire to pursue surgery. Patients were asked to define, using percentages, commonly used verbal semiquantitative terms for levels of risk (low, medium/intermediate, and high). Results212 patients completed surveys. Overall, 84% of patients noted that the actual level of risk was discussed in quantitative or semiquantitative terms; of these patients, 66% reported risk was described using words only. When asked to numerically define low, medium/intermediate, and high risk, patient estimates were markedly discordant, being typically higher, from the usual definitions for these terms as published in the medical literature and as used by medical practitioners. More than 55% of patients surveyed indicated that high risk would correspond to a >50% chance of adverse event, whereas clinicians generally define high risk as >5% chance of adverse event. ConclusionSemiquantitative terms used to define levels of perioperative risk may have very different meanings to patients and practitioners. To facilitate true informed consent, such terms should be avoided and more precise, numerical, quantitative estimates of risk should be used instead.

Wednesday, September 26, 2018 9:00 AM – 10:00 AM Best Papers: 2. Do cervical spine surgery patients recall their preoperative status? A cohort study of recall bias in patient-reported outcomes

BACKGROUND CONTEXT Surgery for cervical degenerative myelopathy or radiculopathy focuses on addressing pain and disability while improving the patients’ quality of life. Although patient-reported outcomes (PROs) are being widely adopted, their ability to be interpreted may be limited by the accuracy of a patient's ability to recall preintervention impairment. PURPOSE Recall bias has been previously investigated in multiple orthopedic and lumbar spine studies, but recall accuracy in cervical spine patients remains unknown. We sought to characterize the accuracy of patient recall as a function of time on validated outcomes after cervical spine surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected outcomes. PATIENT SAMPLE Consecutive series of patients undergoing cervical spine surgery for myelopathy or radiculopathy. OUTCOME MEASURES Numeric pain scale, neck disability index. METHODS We analyzed a consecutive series of patients undergoing cervical spine surgery for degenerative myelopathy or radiculopathy at a single institution. Using standardized questionnaires, we recorded preoperative neck and arm numeric pain scores (NPS), neck disability indices (NDI) and 36-Item Short Form Health Survey (SF-36). Patients were asked to recall their preoperative status through a standardized phone call script and were subsequently stratified based on the timing of their recall into short-term ( 1 year) follow-up sub-groups. Actual and recalled scores were compared using McNemar's or paired t tests, and relations were quantified using Pearson correlation coefficients. Characteristics between the subgroups were compared using Wilcoxon rank sum tests, t-tests, chi-square tests, or Fisher's exact tests as appropriate. RESULTS Seventy-three patients with a mean age of 58.2 years (range 22 to 83 years) were included, with 34 and 39 patients in the short-term and long-term follow-up subgroups patients respectively. The mean period of recall from surgery was 4.6 months and 22.2 months for the short-term and long-term follow-up subgroups respectively. Compared to the preoperative scores, patients showed significant improvement in neck NPS (mean difference [MD]=−2.9, 95% CI −3.5 to −2.3), arm NPS (MD −3.4, 95% CI −4.0 to −2.8), and NDI (MD −12.4%, 95% CI −16.9 to −7.9). Patient recollection of preoperative status was more severe than actual for neck NPS (MD +1.5, p CONCLUSIONS Relying on retrospectively recalled data for outcome assessment does not provide an accurate measure of preoperative status. Prospective collection of PROs remains the gold standard to measure outcomes following cervical spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

45 Patient evaluation of trauma service

Patient Experience of the Trauma System (PETS)Trauma care is highly organised, time critical medicine. Changes to patient management in trauma care are often the result of Random Control Trials, and...

P2.08-004 The Importance of Patient Recall within Cancer Survivorship Care for Improved Post-Treatment Surveillance in Lung Cancer Survivors: Topic: Patient’s Voice, Patient’s Information

Despite widespread endorsement of survivorship cancer care plans, fewer than half of all National Cancer Institute Cancer Centers use them routinely. This may be due to inconsistent evidence linking survivorship care plans and improved cancer outcomes. We sought to examine the association between two specific survivorship care elements and patient reported quality of life and post-treatment cancer surveillance. We studied adults with Stage I or II non-small cell lung cancer having undergone surgical resection (2010-2013). The two survivorship care elements of interest were defined as cancer treatment summary and surveillance plan documentation assessed via chart abstraction. Patient recall of treatment summary was further assessed by patient interview. Patient reported quality of life was assessed via telephone interview using the Functional Assessment of Cancer Therapy-Lung (FACT-L) validated survey instrument. Surveillance imaging was defined as chest CT performed 6 months following resection per NCCN guidelines and was assessed via chart abstraction. Median scores from FACT-L and subscales were compared using non-parametric equality of medians test for univariate analysis and linear regression for multivariable analysis. Surveillance rates were compared using logistic regression. All data were analyzed in STATA 13. A total of 24 patients were interviewed at a median of 9.4 months [Interquartile range 2.8 months] following treatment and 16 patients consented for chart abstraction. For survivorship care elements, 77% of patients had a documented treatment summary, however only 30% of patients recalled receiving a treatment summary when interviewed. A surveillance plan was documented for 50% of patients. For patient reported quality of life, FACT-L total and subscale scores did not differ based on chart documentation of surveillance plan, treatment summary or patient recall of treatment summary. A total of 37% of patients received a post-treatment surveillance CT by 6 months in accordance with guideline recommendations. Chart documentation of surveillance plan was not associated with a difference in receipt of surveillance imaging however, patient recall of treatment summary was associated with increased odds of receipt of surveillance CT (OR 21.25 [95% CI 2.36-191.59, p=0.006) which persisted following adjustment for covariates (OR 24.45 [1.10-543.27], p=0.043). There is a disconnection between documentation of survivorship care and patient recollection of receiving the intended information. This study suggests that efforts aimed at improving the transfer and retention of information might lead to greater adherence to guidelines and receipt of quality cancer care.