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Unfulfilled information needs lead to higher anxiety levels in patients before and after informed consent for spine surgery
EANS Academy. Ringel F. Sep 27, 2019; 276061; EP02071
Abstract
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Objective: After having developed a spinal neurosurgical question prompt list (SN-QPL), we studied when applying simultaneously anxiety, pain and fulfillment of information needs in the context of the informed consent communication.
Methods: We included patients scheduled for elective spine surgery prospectively. They validated the spinal neurosurgical question prompt list (SN-QPL with 4 subscales of satisfactory consistency) and filled in 'The State-Trait Anxiety Operation Inventory' (STOA, including 30 items, 4-point scale ('almost never' - 'almost always', higher scores indicate greater anxiety) before, after informed consent (t1, t2) and postoperatively (t3). STOA is applied in clinical settings to diagnose acute anxiety and anxiety disposition. Association between anxiety, pain (VAS) and fulfillment of information needs at t1-t3 was analyzed.
Results: 118 patients (53 male, mean age 63 years) gave informed consent. Most SN-QPL subscales were positively associated with affective and cognitive state anxiety. The higher affective and cognitive anxiety was at t1, the higher was pain at t3.
Patients with unfulfilled (u) information needs had a higher level of dispositional anxiety in all subscales of SN-QPL than others with fulfilled needs (f). Related to state-anxiety patients with unfulfilled information needs in subscale 'complications and possible postoperative deficits' (u= 2.26 vs. f= 1.88) and 'prognosis and follow up' (u= 2.23 vs. f= 1.75) had more affective and cognitive state anxiety before informed consent consultation (t1, p=0.05 each), and regarding 'prognosis and follow-up' (u= 2.23 vs. f= 1.79) also at t2 (p= 0.01). At t3 cognitive state anxiety was associated with an information deficit in the dimension 'inpatient stay and organizational issues' (u= 2.14 vs. f= 1.79, p= 0.05).
Conclusions: Unfulfilled information needs seem to be linked with higher anxiety. Our SN QPL could help to optimize the pre- and postoperative satisfaction and physician related trust of patients facing spinal surgery when applied adequately.
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