Preoperative Education Program Research Articles

Effects of a Preoperative Patient-Controlled Analgesia Education Program Using Smart Learning in Laparoscopic Cholecystectomy Patients

BackgroundPatients undergoing laparoscopic cholecystectomy develop severe postoperative pain, and this acute pain often becomes chronic. ObjectivesThis study determines the effects of preoperative education on patient-controlled analgesia (PCA) through smart learning in patients using PCA after undergoing laparoscopic cholecystectomies. DesignWe conducted a quasi-experimental study with a nonequivalent control group pretest–posttest design. ParticipantsA total of 60 adult patients aged 20-65 years, admitted for laparoscopic cholecystectomy at a hospital in Korea, participated in a smart learning training program. MethodsThe concept of smart learning, which integrates learning content and solutions with the fourth industrial revolution using mobile devices such as smartphones and media tablets was applied in this study. This smart learning training program comprised three phases: (1) prebriefing, where patients accessed PCA knowledge via a program created by researchers and accessible using a mobile web device (e.g., smartphone or an iPad), with training covering pain characteristics, PCA effects, precautions, and usage methods; (2) simulation, where patients learned using PCA with a machine; (3) debriefing, where patients reviewed their knowledge and skills. ResultsComparing the pain between the experimental and control groups, the pain decreased significantly in both the experimental (Z = –4.40, p < .001) and control groups (Z = –4.41, p < .001), with no significant difference between groups (Z = –1.00, p = .319). Preoperative knowledge significantly increased in both the experimental (Z = –4.74, p < .001) and control groups (Z = –3.55, p < .001), with a significant difference between groups (Z = –6.05, p < .001). Total satisfaction with pain control was higher in the experimental group than in the control group. ConclusionsA structured educational program on PCA use is an effective nursing intervention. PCA educational programs using smart learning could help patients undergoing laparoscopic cholecystectomy understand postoperative pain, promote efficient PCA use, and enhance their satisfaction with pain control.

Exploring Preoperative Experiences and Informational Needs Among Chinese School-Age Children Undergoing Elective Surgery: A Qualitative Study

AimTo understand preoperative experiences and information needs of Chinese school-aged children undergoing elective surgery to design standardized preoperative education programs to alleviate preoperative anxiety. MethodsSemi-structured interviews combined with drawing, writing, and telling techniques were conducted in 12 children. The paintings were interpreted alongside children's verbal expressions. All data were analyzed using thematic analysis. ResultsThree themes emerged: Origins of surgical knowledge: proximity-based knowledge, media exposure, past personal medical experiences, ward-mate interactions, healthcare staff education; Pre-surgery Experiences: anticipation of pain, post-op sensations and impact on life; fantasizing about the operation; being aware of risks; demonstrating psychological resilience; being curious about anesthesia experience; enjoying a break; Preoperative Informational Needs: 55 identified. ConclusionsLack of standardized preoperative education creates a gap between children's knowledge and actual surgical experiences. Developing preoperative education tailored to individualized informational needs and developmental level helps fill their gaps, alleviate preoperative anxiety and improve health outcomes.

The effect of a preoperative education program on the quality of life and the reduction of symptoms of anxiety and depression in patients undergoing a coronary artery bypass graft surgery – a quasi-experimental study

The effect of a preoperative education program on the quality of life and the reduction of symptoms of anxiety and depression in patients undergoing a coronary artery bypass graft surgery – a quasi-experimental study

Benefits of a Single-Session, In-Hospital Preoperative Education Program for Patients Undergoing Ostomy Surgery: A Randomized Controlled Trial.

The purpose of this study was to compare the effects of a 45-minute session of video-based preoperative ostomy education on self-care knowledge, self-care proficiency, anxiety, depression, length of hospital stay, and ostomy-related complications to a control group who received 3 postoperative educational sessions. This was a randomized controlled trial. The sample comprised 47 patients scheduled to undergo ostomy surgery for colon or rectal cancer surgery at a tertiary referral hospital in Seoul, South Korea, from November 2018 to May 2019. However, 2 participants in the intervention group and 4 in the control group withdrew from the study and data analysis is based on 41 participants who completed study procedures. Participants were randomly allocated to an intervention group (n = 21) or a control group (n = 20). The intervention group received a single 45-minute session of video-based preoperative ostomy education along with stoma site marking and postoperative education. The control group underwent stoma site marking and 3 postoperative education sessions Self-care knowledge, anxiety, and depression were assessed by validated instruments. Self-care proficiency was assessed via direct observation using a checklist. Ostomy-related complications were evaluated by a WOC nurse. Length of hospital stay and disease-related characteristics were collected from medical records. Compared with the control group, the intervention group showed significant improvements in self-care knowledge (P = .001) and self-care proficiency scores (P = .001). Intervention group participants also had lower anxiety scores (P = .025), depression scores (P = .014), shorter hospital stays (P = .008), and fewer ostomy-related complications (P = .001). In patients undergoing ostomy surgery, a single 45-minute session of preoperative video-based ostomy education improved self-care knowledge and proficiency. This intervention also reduced depression, anxiety, and ostomy-related complications.

Balancing clinician and patient priorities for total shoulder replacement preoperative education programs

ObjectiveTo investigate patient and clinician preferences regarding a preoperative educational program for patients undergoing shoulder replacement surgery. MethodsThis study used a cross-sectional survey of patients awaiting shoulder replacement surgery and clinicians. The survey was comprised of 41 questions for patients and clinicians, regarding preferences for receiving information, content preferences and device preferences. Descriptive statistics were reported for survey questions. Results180 patients and 175 clinicians completed the survey. Patients and clinicians’ top choices for ways to receive information were: in-person, website and booklets, with use of CD/DVD being extremely unlikely. Patients and clinicians had different preferences regarding content choices. Patients rated the following content topics as important to include in a program: including other patient’s previous experiences with this surgery (83 % patients; 40 % clinicians), information for caregivers (84 % patients; 65 % clinicians), expectations for hospital stay (89 % patients; 57 % clinicians), process of anesthesia (87 % patients; 51 % clinicians), and how the surgery is performed (94 % patients; 60 % clinicians). ConclusionsClinicians and patients have differing priorities and perspectives on the content and delivery of preoperative education programs, however, therapeutic goals and accessibility should be considered when designing programs. Practice ImplicationsCreating education programs should include the lens of both clinicians and patients.

The Impact of Preoperative Education on Reducing Anxiety among Patients Undergoing Elective Surgery at Shahidan Qaladze Teaching Hospital in Kurdistan Region/Iraq

Background: Preoperative anxiety is a common reaction experienced by patients who are admitted to the hospital for surgery. It can be described as an unpleasant state of tension or uneasiness that results from a patient's doubts or fears before an operation. Aim: Examine the effect of an educational intervention for patients who are scheduled for a surgical operation on reducing their anxiety prior to the surgery. Methods: This quasi-experimental/Static-group comparison design was used to on a purposive sample of 150 patients attending operation waiting room in Shahidan Qaladze Teaching Hospital from May 28 to July 27, 2022. Data were collected by direct interview. The patients were divided into two groups; the control and the educational group. Results: 150 participants were selectedpurposively, (75 control; 75 educational) group. Participants who received a preoperative education program experienced a greater decrease (30.906±6.959) in anxiety scores (Mean difference =14.146, 95% confidence interval 11.54 to 16.75; P-value < 0.001) compared with those who did not (45.053±9.043). More than half (65.3%) of the control group participants experienced severe preoperative anxiety while the majority (88%) of the intervention group who received the education program experienced mild anxiety as suggested by the S-STAI score. Conclusions: The verbal education before surgery has a significant effect on reducing patients’ anxiety before they transfer to the operating room.

Preoperative Patient Education Practices and Predictors Among Nurses Working in East Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022.

The time before surgery is a traumatic period for patients. Despite this fact, no research has been conducted on nurses' preoperative patient education in Ethiopia. This study aimed to assess preoperative patient education practices and associated factors among nurses working in East Amhara comprehensive specialized hospitals, Ethiopia, 2022. A hospital-based cross-sectional study was conducted with 416 nurses. Pretested, structured questionnaires were used to collect the data. Bivariable analysis was performed for each independent variable with a P-value < 0.25 on the data imported to multivariate logistic regression analysis. AOR with a 95% CI and a P-value < 0.05 at a 5% level of significance were considered. Only 38.5% of nurses were found to have good practices for preoperative patient education, with a response rate of 98%. Nurses with 6 years of work experience (AOR = 3.15, 95% CI: 1.692-5.874), adequate time (AOR = 2.33, 95% CI: 1.119-4.889), training (AOR = 4.27, 95% CI: 1.548-11.796), age 25-29 (AOR = 0.15, 95% CI: 0.070-0.331), age 30-34 (AOR = 0.25, 95% CI: 0.137-0.479), and knowledge (AOR = 3.73, 95% CI: 2.222-6.273) were significantly associated. Preoperative patient education practices among nurses were poor. Work experience, knowledge, training, and adequate time were found to be significant. Organize preoperative patient education programs for nurses that share experiences and provide ongoing training.

The Efficacy of a Preoperative Occupational Therapy Educational Session for Saudi Patients Undergoing a Lower Extremity Joint Replacement.

Prior to a lower extremity joint replacement, many surgical candidates participate in a preoperative occupational therapy educational program that is meant to increase patient awareness, promote positive health behaviors, and improve health outcomes after surgery. With the limited number of occupational therapists in Saudi Arabia, patients may only receive one preoperative educational session. The objective of the study was to explore the efficacy of one preoperative occupational therapy educational session for patients undergoing a lower extremity joint replacement. A total of 19 participants were included in the study, 7 participants to the intervention and 12 participants to the control groups. Participants underwent either a total knee or total hip replacement. The intervention group received one preoperative educational session prior to the surgery and the control group received usual care. After the surgery, both groups were assessed on pain (SF-MPQ), Satisfaction (SPSQ), Quality of life (QOLS), functional performance (FIM). Mann-Whitney U-tests were used to compare between groups. The findings showed significant improvements in both pain (12.14 ± 7.22 vs 21.25 ± 8.60; p=0.02) and satisfaction (106.28 ± 25.17 vs 78.08 ± 31.49; p=0.03) when compared to usual care. Although both FIM and QOLS scores indicated improvements when compared to usual care, these results were not statistically significant. Effect sizes showed moderate and large effects for score differences on both the SF-MPQ and SPSQ (r= 0.47, r=0.52) respectively. Whereas effect sizes for score differences on both the FIM and QOLS were small. An occupational therapy preoperative education session shows promise for patients undergoing lower extremity joint replacement; however, further research is needed to confirm these findings.

Prehabilitation and education in major abdominal and thoracic surgery reduces length of stay and ventilation days

INTRODUCTION: Poor cardiopulmonary fitness is associated with an increased risk of morbidity and mortality following major surgery. Targeted prehabilitation interventions with adequate intensity improve cardiopulmonary function. Several systematic reviews have noted the variation in outcomes for prehabilitation, providing poor evidence due to inadequate patient numbers and poor compliance. Our aim was to assess the outcomes of the Preoperative Education and Prehabilitation Program (PrEPP) for patients undergoing major abdominal or thoracic surgery. METHODS: PrEPP is a supervised education and exercise training program twice a week and an at-home exercise program three times a week for up to four weeks. A comparison of outcomes was made using the data collected on each patient in PrEPP with a historical control group. RESULTS: There were 370 patients, 185 in each group. They were matched for age (+/- 10 years), gender, and surgery type. There were significant reductions in prolonged ventilation (&gt;48 hours) from 5.4% to 1.1% (p = 0.03) and mean length of stay (LOS) from 10.2 days to 8.5 days (p = 0.04) in the PrEPP group. The incidence of superficial surgical site infection was also found to be less in the PrEPP group (p = 0.02). There were no significant differences in the incidence of pneumonia (3.8% to 2.7%), unplanned re-intubation (3.8% to 1.6%), readmission rate (12.4% to 9.7%), cardiac events or other post-surgical infections. CONCLUSION: The PrEPP was associated with reduced ventilation days and LOS. Further studies are required to confirm these results.

Improving Patient Activation Measure® in lower limb arthroplasty: Quantitative assessment of patient activation following a pre-operative patient education programme.

Improving Patient Activation Measure® in lower limb arthroplasty: Quantitative assessment of patient activation following a pre-operative patient education programme.

Preoperative Patient Education Programs for Orthopaedic Surgery: What Do the Programs Include? How Are They Delivered? What Are the Knowledge Gaps? A Scoping Review of 46 Studies.

To (1) describe the nature and content of the current literature on preoperative education programs for patients preparing for orthopaedic surgery, (2) assess the completeness of reporting program descriptions, and (3) report gaps within the literature. Scoping review. We searched the CINAHL, Embase, PubMed, Cochrane Reviews, PsycINFO, Web of Science, and Google Scholar databases for studies that (1) addressed preoperative education in elective orthopaedic surgery or (2) provided descriptions or evaluations of a preoperative program, including the content or outcomes of the program. Articles were included if they addressed preoperative patient education focused on an elective orthopaedic surgery and any of the (1) descriptions of an education program including any theoretical frameworks, content, or delivery, or (2) evaluations of the process of a preoperative educational program. Studies were excluded if they were treatment programs with the goal of resolving the problem occurring prior to surgery (eg, rehabilitation or pain management prior to surgery). We used the template for intervention description and replication (TIDieR) checklist and guide to assess the completeness of reporting of the content of educational programs. Content was synthesized descriptively and by intervention mapping. The results informed of a draft operational definition of preoperative education that we refined based on expert consultation. Forty-six articles were included. There was variation in study designs, target populations, and intervention content. Preoperative education was defined in 1 out of 5 studies. Thirteen studies used a platform of video-based modules to deliver their program; 3 studies implemented virtual platforms. Results from the TIDieR checklist indicated that 30% of studies tracked adherence to and fidelity of their programs. A definition and conceptual map indicated that the length of stay, functional abilities, patient knowledge, and satisfaction were expected benefits. Poor reporting of content, rationale, and frameworks for preoperative programs in orthopedics may explain why systematic reviews have not found support for their value. Future trials must improve rigor in design and reporting. J Orthop Sports Phys Ther 2022;52(9):572-585. Epub: 9 July 2022. doi:10.2519/jospt.2022.10614.

PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL)

BackgroundRadical surgery is the mainstream treatment for patients presenting with advanced primary or recurrent gastrointestinal cancers; however, the rate of postoperative complications is exceptionally high. The current evidence suggests that improving patients’ fitness during the preoperative period may enhance postoperative recovery. Thus, the primary aim of this study is to establish the effectiveness of prehabilitation with a progressive, individualised, preoperative exercise and education program compared to usual care alone in reducing the proportion of patients with postoperative in-hospital complications. The secondary aims are to investigate the effectiveness of the preoperative intervention on reducing the length of intensive care unit and hospital stay, improving quality of life and morbidity, and reducing costs.MethodsThis is a multi-centre, assessor-blinded, pragmatic, comparative, randomised controlled trial. A total of 172 patients undergoing pelvic exenteration, cytoreductive surgery, oesophagectomy, hepatectomy, gastrectomy or pancreatectomy will be recruited. Participants will be randomly allocated to prehabilitation with a preoperative exercise and education program (intervention group), delivered over 4 to 8 weeks before surgery by community physiotherapists/exercise physiologists, or usual care alone (control group). The intervention will comprise 12 to 24 individualised, progressive exercise sessions (including aerobic/anaerobic, resistance, and respiratory exercises), recommendations of home exercises (16 to 32 sessions), and daily incidental physical activity advice. Outcome measures will be collected at baseline, the week prior to surgery, during the hospital stay, and on the day of discharge from hospital, and 1 month and 1 months postoperatively. The primary outcome will be the development of in-hospital complications. Secondary outcomes include the length of intensive care unit and hospital stay, quality of life, postoperative morbidity and costs.DiscussionThe successful completion of this trial will provide robust and high-quality evidence on the efficacy of a preoperative community- and home-based exercise and education intervention on important postoperative outcomes of patients undergoing major gastrointestinal cancer surgery.Trial registrationThis trial was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12621000617864) on 24th May 2021.

Analysis of Risk Factors for High-Risk Patients Undergoing Total Joint Arthroplasty.

BackgroundThe purpose of this study is to evaluate and redefine patients at high risk for increased resource utilization and complications after total joint arthroplasty (TJA), so interventions may focus on patients standing to receive the most benefit.Material and methodsThis is a retrospective study of 787 patients undergoing primary unilateral TJA from September 1, 2020, to September 31, 2021. Patients were deemed to be at “high risk” based on criteria derived from published literature and triaged to an enhanced preoperative education program. Patients that were discharged to a skilled nursing facility, had a length of stay ≥ 2 days, returned to the emergency department, or readmitted within 30 days were classified as having a composite outcome. A univariate analysis compared patients who did and did not experience the composite outcome, and multivariate regression was performed to evaluate predictors of this endpoint.ResultsDifferences in rates of 5 of the 28 risk factors were present between patients who did and did not experience composite outcomes. After controlling for other factors, African American race, planned discharge to skilled nursing facility, mental health conditions or drug use, cardiac, and neurologic conditions were predictive of the composite outcome. Patients who were reclassified as “high risk” with 1 or more of these characteristics, experienced longer length of stay and lower rates of home discharge than the rest of the population.ConclusionThis study presents a profile of high-risk TJA patients that can be incorporated into clinical practice for risk stratification and targeted intervention.

A Preoperative Spinal Education intervention for spinal fusion surgery designed using the Rehabilitation Treatment Specification System is safe and could reduce hospital length of stay, normalize expectations, and reduce anxiety : a prospective cohort study.

AimsPsychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS.MethodsPOSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests.ResultsIn all, 65 (43%) patients (mean age 57.4 years (SD 18.2), 58.8% female) comprised the Attend-POSE, and 85 (57%) DNA-POSE (mean age 54.9 years (SD 15.8), 65.8% female). There were no significant between-group differences in age, sex, surgery type, complications, or readmission rates. Median LOS was statistically different across Pre-POSE (5 days ((interquartile range (IQR) 3 to 7)), Attend-POSE (3 (2 to 5)), and DNA-POSE (4 (3 to 7)), (p = 0.014). Pairwise comparisons showed statistically significant differences between Pre-POSE and Attend-POSE LOS (p = 0.011), but not between any other group comparison. In the Attend-POSE group, there was significant change toward greater surgical preparation, procedural familiarity, and less anxiety.ConclusionPOSE was associated with a significant reduction in LOS for patients undergoing spinal fusion surgery. Patients reported being better prepared for, more familiar, and less anxious about their surgery. POSE did not affect complication or readmission rates, meaning its inclusion was safe. However, uptake (43%) was disappointing and future work should explore potential barriers and challenges to attending POSE.Cite this article: Bone Jt Open 2022;3(2):135–144.

The Impact of a Pre-Operative Spinal Education (POSE) program on post-operative length of stay following spinal fusion surgery

Purpose: Offering psycho-educative discourse and information prior to elective lower-limb joint replacement surgery improves rehabilitative outcomes by better managing patients’ expectations. Our tertiary orthopaedic service in a large urban UK NHS Trust has found anecdotally that elective spinal surgery patients experience pre-surgery anxiety relating to expected pain and immobility, which might prolong their post-surgical hospital length-of-stay (LOS). But it remains unknown whether pre-surgical psycho-educative approaches are beneficial in minimising LOS in this patient group.

Enhanced Recovery Program: Does Preoperative Education Reduces Length of Hospital Stay in Primary Hip and Knee Arthroplasty?

IntroductionTotal knee and hip arthroplasty significantly improve the quality of life in people suffering from end-stage hip and knee arthritides. Enhanced recovery programs have shown improved outcomes following elective arthroplasty by decreasing patients’ anxiety, postoperative pain and reducing the length of hospital stay (LOS). The aim of our study is to evaluate the impact of preoperative education programs on LOS in patients undergoing hip and knee arthroplasty.MethodsRetrospective data was collected from a consecutive series of 520 patients’ charts and the Irish National Orthopaedic Register (INOR) for those who underwent hip or knee arthroplasty from January 1, 2018 to December 31, 2018 in our hospital. The LOS study compared 226 patients in the Educational Group (EG) who attended the Hip & Knee School (Preoperative Education Class) with 294 patients in the Conventional Group (CG) who did not attend the hip and knee educational program. ResultsWe identified that LOS decreased to 5.2 days in EG from 5.5 days in CG (p-value equals 0.26, statistically insignificant, t = 1.1093, df = 518), with a mean difference of only 0.3 days (95% CI). ConclusionPreoperative education does not reduce the LOS in primary hip and knee arthroplasty.

Discharge Transition Experience for Lumbar Fusion Patients: A Qualitative Study.

ABSTRACTBACKGROUND: Support should be provided to individuals who are ready to be discharged; however, quantitative research is lacking in understanding the challenges of postsurgery lumbar fusion patients' discharge and transition. This article delves into the in-depth experience of lumbar fusion patients with discharge transitions. METHODS: We conducted semistructured individual interviews with 11 patients who had lumbar fusion surgery at one of Korea's most equipped general hospitals. These interviews focused on the patients' discharge transition experiences. The data were analyzed using phenomenological analysis. RESULTS: Lumbar fusion patients' experiences of discharge transition fit into 4 categories: anticipation of surgical transition, the process of transition to discharge, the difficult process of recovery, and recovery strategy. CONCLUSION: To further expedite the discharge process and make better use of cooperative hospital resources, conducting preoperative treatment planning, identifying family and social support systems, and sharing treatment procedures are all required. Furthermore, thorough health information services and step-by-step courses on predicted problems and everyday living after surgery should be considered for postoperative education. It is critical to broadening the scope of preoperative and postoperative education programs, as well as assistance for the social support system, such as the family-based support system and cooperative hospitals.

P23: ENHANCED RECOVERY PROGRAMME – DOES PREOPERATIVE EDUCATION REDUCE LENGTH OF HOSPITAL STAY (LOS) IN PRIMARY HIP &amp; KNEE ARTHROPLASTY

Abstract Introduction Total knee and hip arthroplasty significantly improve quality of life in people suffering from end-stage hip &amp; knee arthritides. Enhanced recovery programs have shown improved outcomes following elective arthroplasty by decreasing patients anxiety, postoperative pain and reducing the length of hospital stay (LOS). The aim of our study is to evaluate the impact of preoperative education programs on length of hospital stay in patients undergoing hip &amp; knee arthroplasty. Method Retrospective data was collected from a consecutive series of 520 patients' charts and Irish National Orthopedic Register (INOR) who underwent Hip or Knee arthroplasty from January 1, 2018, to December 31, 2018, in Our Lady Hospital, Navan. The length of stay study compared two hundred and twenty-six patients in the Educational Group (EG) who attended the Hip &amp; Knee School (Preoperative Education Class) with 294 patients in the Conventional Group (CG) who did not attend the hip and knee educational programme. Result We identified that Length of Hospital Stay decreased to 5.2 days in Educational Group from 5.5 days in Conventional Group (P-value equals to 0.26, statistically insignificant, t = 1.1093 df = 518), with a mean difference of only 0.3 days (95% confidence interval). Conclusion Preoperative education does not reduce the length of hospital stay in primary hip &amp; knee arthroplasty. Take-home message Preoperative education has no role in reducing hospital stay in Arthroplasty patients.

A qualitative evaluation of a nurse-led pre-operative stoma education program for bladder cancer patients

IntroductionRadical cystectomy remains the standard of care for muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. Postoperative ostomy education is common, but patients struggle to maintain self-management practices. A preoperative ostomy education program was developed to meet this need, and we conducted a qualitative study with participating patient-caregiver dyads to evaluate the educational and psychosocial impacts of the program and examine alignment with program objectives.Materials and methodsA qualitative descriptive study was conducted utilizing a thematic analysis approach. Sixteen patients, eighteen caregivers, and three program educators completed semi-structured interviews from 3 to 18 months post the program. Interviews were audio-recorded and transcribed. Thirteen end-of-course surveys from the initial educational program cohort were transcribed, coded, analyzed; this data was triangulated with patient, caregiver, and educator interviews.ResultsAnalysis uncovered three themes: (1) Patient and caregiver motivation to attend the program, (2) attitudes toward this life-changing event, and (3) education. For theme 1, patients and caregivers cited lack of knowledge, fear, and concern about ostomy surgery and care as motivation. For theme 2, there were a variety of attitudes toward the ostomy, ranging from avoidance to acceptance, and a similar breadth of attitudes toward caregiving, with some patients and caregivers describing ongoing dependence and other patients seeking complete independence. For theme 3, the interactive curriculum was determined to be effective, and the patient advocate was cited as the most memorable program component.ConclusionsA formal preoperative ostomy education program employing an interactive educational approach and featuring a patient advocate can prepare bladder cancer patients and caregivers for ostomy self-management and post-ostomy life.

Brief preoperative mind-body therapies for total joint arthroplasty patients: a randomized controlled trial.

Although knee and hip replacements are intended to relieve pain and improve function, up to 44% of knee replacement patients and 27% of hip replacement patients report persistent postoperative joint pain. Improving surgical pain management is essential. We conducted a single-site, 3-arm, parallel-group randomized clinical trial conducted at an orthopedic clinic, among patients undergoing total joint arthroplasty (TJA) of the hip or knee. Mindfulness meditation (MM), hypnotic suggestion (HS), and cognitive-behavioral pain psychoeducation (cognitive-behavioral pain psychoeducation) were each delivered in a single, 15-minute group session as part of a 2-hour, preoperative education program. Preoperative outcomes-pain intensity, pain unpleasantness, pain medication desire, and anxiety-were measured with numeric rating scales. Postoperative physical functioning at 6-week follow-up was assessed with the Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test. Total joint arthroplasty patients were randomized to preoperative MM, HS, or cognitive-behavioral pain psychoeducation (n = 285). Mindfulness meditation and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. Mindfulness meditation also decreased preoperative pain medication desire relative to cognitive-behavioral pain psychoeducation and increased postoperative physical functioning at 6-week follow-up relative to HS and cognitive-behavioral pain psychoeducation. Moderation analysis revealed the surgery type did not differentially impact the 3 interventions. Thus, a single session of a simple, scripted MM intervention may be able to immediately decrease TJA patients' preoperative clinical symptomology and improve postoperative physical function. As such, embedding brief MM interventions in surgical care pathways has the potential to improve surgical outcomes for the millions of patients receiving TJA each year.