For Patients, Pre-Surgery Education Is Lacking

This is the second article in a two-part series.

When it comes to pre-surgery education for patients, healthcare leaders have their work cut out for them.

But it's work worth doing. The positive relationship between patient education and post-surgery outcomes has significant implications for patients, healthcare providers and medical device manufacturers.

As reported in our earlier article, Gallup researchers asked patients undergoing medical device implantation about three important aspects of pre-surgery education. Patients were asked to rate their level of agreement with the following statements using a scale of 1 (strongly disagree) to 5 (strongly agree):

• I knew what to expect after surgery.
• I was prepared for my experience post-surgery.
• I followed post-surgery instructions, such as rehabilitation or medication.

Gallup's analysis showed that each of these aspects of pre-surgery education substantially affected post-surgery outcomes. Patients who strongly agreed with just one of these statements had higher satisfaction and lower problem incidence compared with patients who did not strongly agree (giving a rating of 1 to 4). And when patients strongly agreed with two or three of these statements, they experienced even greater outcomes, including increased overall satisfaction and lower problem incidence.

Patients who strongly agreed with two or more statements also experienced physical and emotional consequences of surgical outcomes that extended well beyond the scope of the procedure to affecting five key areas of personal well-being. Gallup and Healthways have identified five essential elements of well-being -- purpose, social, financial, community and physical -- that encompass the most important parts of how people think about and experience their lives and collectively signify a life well-lived. For each aspect of patient education, patients who strongly agreed with a statement were about twice as likely to be thriving in all five well-being elements as patients who did not strongly agree.

The vital finding that healthcare providers should heed is that taking the time to educate patients before a procedure has significant consequences for patients, their friends and families, and their community. But before healthcare leaders take action to improve patient education and communication, they need to know where the biggest gaps exist in these areas.

Significant Room for Improvement

When Gallup surveyed hospital patients who had received a medical implant, only 37% of respondents strongly agreed with all three aspects of patient education, while 17% strongly agreed with none of them. This finding suggests that there is significant room to improve patients' pre-surgery education. For two of the patient education items ("I knew what to expect after surgery" and "I was prepared for my experience post-surgery") there are sizable gains to be made, with less than half of respondents (46%) strongly agreeing with either of these items.

While all three items improve surgical outcomes, these elements influence them in different ways. Though it's arguably difficult for healthcare providers or device manufacturers to influence patient adherence to post-surgery rehabilitation and medication regimes, Gallup's research indicates that patients take care of their part: The vast majority (78%) strongly agreed that they followed post-surgery instructions. Because less than half of patients strongly agreed with the other two items ("I knew what to expect after surgery" and "I was prepared for my experience post-surgery") Gallup's analysis indicates that tailored pre-surgery communication is the key to successful post-procedure outcomes.

Before they can adapt pre-surgery education to meet patient needs, healthcare leaders must know where it is most lacking. Gallup finds the biggest gap between pre-surgery patient education and post-surgery outcomes among Generation X males (born 1965-1979) and millennial males (born 1980-1996) who are undergoing acute procedures (versus elective and cardiac procedures). Though there is room for improving patient education across the board, hospital leaders could enhance patient outcomes by reassessing their education strategy and messages for these key patient segments. By taking steps to understand the education gaps for various patient groups and demographics, leaders can ensure that they maintain a strong, proactive approach in education for all patients.

How to Improve Patient Education

Healthcare providers and medical device companies can improve patient outcomes significantly by refining patient communication and education. The following are a few best practices to help leaders make this happen.

What healthcare leaders should do:

• Emphasize proactive communication. When patients have well-informed expectations, they tend to be less anxious before procedures and less surprised after them. Hospitals can emphasize the importance of proactive communication by equipping doctors, nurses and staff with knowledge, experience and materials to meet patients' education needs. They should also implement a system of accountability to ensure that doctors, nurses and staff are prepared to talk with patients about their upcoming procedure -- and that patients receive that education consistently.
• Use checklists. Following studies and articles by respected physicians such as Atul Gawande and Peter Pronovost, the use of checklists during surgery has profoundly reduced surgical and medical errors. A similar strategy, founded in best practices for when, what and how to educate patients, can help providers ensure that patients understand crucial pre- and post-surgical expectations.
• Tailor communication to each patient. Healthcare providers should personalize communications to meet each patient's needs, including individualizing the content and how doctors, nurses and staff deliver it. Focus groups with former patients can help providers determine how different patient groups best understand and retain health information. Because Gen X and millennial males undergoing acute procedures are most likely to benefit from enhanced education and communication, hospitals should start by revitalizing communication efforts with these two groups.

What medical device company leaders should do:

• Develop and maintain easily accessible content. Though healthcare providers are primarily responsible for direct patient education, medical device companies also have a stake in enhancing communication to increase patient satisfaction. Company leaders can do their part to further patient education by developing and maintaining educational content that is credible and delivered through many types of communication channels, including traditional and social media. These offerings inform patients about the best available options, increase brand awareness and build consumer trust, encouraging consumers to ask for products from a specific company.
• Understand and accommodate patient-surgeon disconnects. Providing patients and surgeons with simple, easy-to-use materials can further enhance patient comprehension and buy-in. Surgeons will benefit from materials that make it easy to explain procedures to patients. Patients will benefit from materials that help them understand the procedure and from surgeons who can provide additional information if they have questions.
• Anticipate and answer patient questions. Patients' information needs change over time, and materials written a year or more ago may already be outdated. Surgeons and hospital staff will be the first to know when materials become obsolete because patients' questions will change or increase. Asking surgeons for feedback on the questions patients ask most often about their procedures can help companies keep educational content current and relevant as technology and patient needs change.

Survey Methods

Results are based on a 2014 medical device Gallup Panel Web and mail study completed by 26,128 national adults, aged 18 and older, conducted Aug. 5-Sept. 16, 2014. Results of the well-being analysis are a combination of four studies: a 2014 medical device study, a 2014 health experience study, a 2014 well-being study and a 2013 well-being study. The Gallup Panel is a probability-based longitudinal panel of U.S. adults who Gallup selects using random-digit-dial phone interviews that cover landline and cellphones. Gallup also uses address-based sampling methods to recruit Panel members. The Gallup Panel is not an opt-in panel and panel members do not receive incentives for participating. In this study, 2,639 respondents reported that they had medical implants in the last 12 months, which is the total sample for the results reported in this article. For results based on this sample, one can say that the maximum margin of sampling error is ±1.9 percentage points, at the 95% confidence level. Margins of error are higher for subsamples. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.