Artikel
Anxiety and pain are linked to the patients’ information needs assessed by a question prompt list (QPL) – in the context of informed consent for spine surgery
Angst und Schmerz sind im Kontext der Aufklärung bei spinalen Operationen mit dem Informationsbedarf der Patienten verbunden – Ergebnisse auf einer Erhebung mittels einerFragenidentifikationsliste
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Autoren
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Sabine Fischbeck
- Unimedizin Mainz, Med. Psychologie, Mainz, Deutschland
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Rebecca Nesbigall
- Unimedizin Mainz, Neurochirurgie, Mainz, Deutschland; Unimedizin Mainz, Med. Psychologie, Mainz, Deutschland
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Julian Haaf
- Unimedizin Mainz, Neurochirurgie, Mainz, Deutschland; Unimedizin Mainz, Med. Psychologie, Mainz, Deutschland
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Wilfried Laubach
- Unimedizin Mainz, Med. Psychologie, Mainz, Deutschland
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Katja Petrowksi
- Unimedizin Mainz, Med. Psychologie, Mainz, Deutschland
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Florian Ringel
- Unimedizin Mainz, Neurochirurgie, Mainz, Deutschland
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Mirjam Renovanz
- Unimedizin Mainz, Neurochirurgie, Mainz, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: We developed a spinal neurosurgical question prompt list (SN-QPL) and studied at the same time anxiety, pain and fulfillment of information needs in the context of the informed consent communication.
Methods: Patients scheduled for elective spine surgery were prospectively recruited. They validated the SN-QPL, consisting of 4 subscales with satisfactory consistency. At the same time they filled in “The State-Trait Anxiety Operation Inventory” (STOA) consisting of 30 items rating by a 4-point scale (“almost never” – “almost always”, higher scores indicate greater anxiety) before and after informed consent (t1, t2) and postoperatively (t3). STOA is applied in clinical settings to diagnose acute anxiety in a situation (“state anxiety” including an affective and a cognitive component) and the anxiety disposition of a person (trait anxiety). We analyzed the association between anxiety, pain (VAS) and fulfillment of information needs at t1-t3.
Results: 118 patients (53 male, mean age 63.3 years) gave informed consent. SN-QPL subscales were positively associated with affective (except subscale “safety of the surgical procedure”) and cognitive state anxiety. The higher affective and cognitive anxiety was at t1, the higher was pain at t3 (affective anxiety t1: mean 2.24, p<0.01, cognitive anxiety t1: mean 2.46, p>0.001). 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 (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).
Conclusion: 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.
