Patients appear to want information about different options for regional anaesthesia for post-operative pain, yet it seems that they wish to be relatively passive when it comes to making a choice, according to results of a survey presented at the 2014 Annual Meeting of the American Society of Anesthesiologists (ASA).
Shared decision-making (SDM), a patient-centred decision-making process that encourages active patient engagement in preference-sensitive healthcare decisions, is a national priority under the Affordable Care Act. Regional anaesthesia for procedures and post-operative pain management becomes a preference-sensitive decision when there is more than 1 medically appropriate option, according to Karen Posner, PhD, University of Washington, Seattle, Washington.
Dr. Posner and colleagues, whose purpose was to assess the needs and attitudes of patients toward choosing anaesthesia options before introducing SDM into the pre-anaesthesia clinic, surveyed those likely to be offered a choice of regional anaesthesia for their procedure or post-operative pain management.
The survey asked patients about their desire for information, tested their knowledge about anaesthesia, and asked if their doctors should decide which anaesthesia choice was best for them. Data were compiled for 196 patients, who were then classified as having active (54), collaborative (87), or passive (48) control preferences in sharing treatment decisions with their healthcare professional. The 3 groups were compared using Fisher’s exact test.
Most survey respondents (86%) agreed that it is important to discuss anaesthesia and postoperative pain-management choices during the pre-anaesthesia clinic visit. Half of the respondents wanted to receive written information about regional anaesthesia during the visit. Patient knowledge about regional anaesthesia was generally low, but was higher among patients who had previously experienced regional anaesthesia. Nearly 60% of experienced patients versus 22% of inexperienced patients knew that regional anaesthesia numbs part of the body (P < .001).
While most of the respondents in all 3 groups agreed that their anaesthesiologist and surgeon should choose the best anaesthesia and post-operative pain management for them, patients with active or collaborative control preferences were less likely (65% in each group) than passive patients (86%) to allow their physicians to make choices for them (P = .048). One in five (20%) patients with active control preferences did not agree that their physicians should choose, compared with 13% of collaborative patients, and 9% of passive patients. There was no significant difference concerning the same issue between patients who had previously experienced regional anaesthesia and those who had not.
The survey respondents had a mean age of 65 ± 14 years, 51% were male, 72% had some education beyond high school, 50% had previously experienced regional anaesthesia.
The researchers concluded that patients want information about different anaesthesia options, but appear to be relatively passive in choosing among them. This may have to do with the low level of knowledge about regional anaesthesia, the team noted.
Follow up will include a survey assessing whether providing anaesthesia decision aids and engaging patients in shared decision-making results can encourage patients to be more engaged in choosing between anaesthesia options. During transition to the perioperative surgical home model of care, consideration should be given to engaging patients in discussions about choosing anaesthesia when regional anaesthesia is an option.