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

Previous studies have shown that multimedia educational interventions can reduce anxiety and foster an understanding of the processes and risks of cardiac surgery for patients 18 and their family members, 17 regardless of the format to convey the patient education: using tape, 19 written leaflets 18 20 or verbally during the preoperative visit by ICU or specialist cardiac nurses. 18 20 Additionally, results from a multicentre study in a non-cardiac ICU 21 showed that disclosing all the available information in a frank, direct and empathetic way could meet the informational needs of family members about the patients and thus, they were more satisfied; conversely, families who felt that they had received contradictory information had 21.1% lower satisfaction scores than their counterparts. 21 Effect of patient education Having a preoperative patient education programme which provides sufficient information on the risk and process of surgery to patients may help to increase their satisfaction levels and reduce their anxiety levels. A randomised controlled trial 18 of a preoperative educational intervention (usual care plus information leaflet and verbal advice) versus usual care for patients undergoing cardiac surgery showed a moderate reduction in anxiety levels (adjusted mean difference −3.6, 95% CI −4.62 to −2.57) and depression levels (adjusted mean difference −2.1, 95% CI −3.19 to −0.92) using the Hospital Anxiety and Depression Scale (HADS). Another recent study showed that an effective nurse-led preoperative education not only reduced anxiety levels, but also reduced the risk of postoperative complications, such as sternal infection, in cardiac surgical patients. 22 However, the evidence to support benefits from patient education in the ICU setting is mixed. In a recent multicentred randomised controlled trial of a structured information programme during the ICU stay as compared with a non-specific conversation of similar duration, there was no reduction in patient anxiety levels (mean difference −0.2, 95% CI −4.5 to 4.1, on a scale from 0 (no anxiety) to 100 (maximum anxiety)) in medical and surgical critically ill ICU patients. 23 In a cross-sectional study of family members visiting ICU patients, although there was a moderate correlation between family perception of informational support and satisfaction with care (r=0.74, p<0.001), very little correlation between informational support and anxiety levels (r=−0.13, p=0.50) was found. 24 Neither of the two studies provided information about the ICU before the ICU admission. 23 24 A non-randomised study examining the effect of a preoperative ICU tour prior to cardiac surgery failed to detect a significant difference in anxiety levels between the control (no ICU tour) and treatment (ICU tour) after adjusting for previous ICU experience ( p=0.43). 25 Nevertheless, the authors showed that patients in the treatment group perceived the tour to be beneficial for themselves and for future patients. 25 In addition, other studies found that in order to reduce psychological distress, both ICU nurses and patients believed that preoperative patient education led by ICU nurses explaining the reasons for ICU admission, ICU environment and the expected postoperative care would be beneficial. 26 27 Significance of the present study The previous studies discussed above have focused individually on the separate issues of satisfaction with general ICU care, preoperative psychological distress and info