Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention

Lai, Veronica Ka Wai; Lee, Anna; Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John; Joynt, Gavin Matthew

Several family satisfaction surveys measuring satisfaction with general ICU care have been developed with sound psychometric properties, and have been reviewed elsewhere. 4 The key domains related to family satisfaction include ICU environment 5 6 and process of care, 5 sufficient information, and quality communication with medical professionals to make important decisions about care. 5 7 In order to improve the quality of care in ICU, it is essential to examine the perspectives of the patients and their family members, 6 8 and implement strategies to address areas of concern. As an example of the impact of the environment of ICU on patients, the satisfaction levels of patients and family members increased by 6% with the changes due to a shift from a ward with multiple beds to a newly designed ICU with noise-reduced, single rooms with daylight and improved family facilities. 6 Patient and family psychological distress Surgical patients encounter physical trauma and psychological distress after surgery. 9 10 Psychological distress has been defined as a collective term for anxiety and depression levels. 11 Beyond that, an unfamiliar hospital environment, such as the ICU, is another stressful factor that is associated with high anxiety and depression levels. 12 In coronary artery bypass grafting (CABG) patients, anxiety and depression occurs for several reasons: (1) routine procedures during ICU admission, for instance, oral and nasal tubes are important stressors 13 because they result in an inability to talk, affecting communication with ICU staff and (2) the associated time spent on the waiting list before the surgery. The prevalence of clinically significant anxiety and depression in patients awaiting CABG was 28% and 47%, respectively. 14 Results from a systematic review found that higher levels of preoperative anxiety and depression in CABG patients were predictive of psychological distress in the postoperative period. 15 Generally, family members were significantly more anxious than patients themselves about the cardiac surgery. 16 However, family members of the cardiac surgery patients reported lower level of anxiety and high satisfaction if their informational needs about the surgery and treatment of the patients were fulfilled. 17