I.C. Cohen1, S. Watson1, P. Sweeney3, M. Reilly2, K.J. Ho2 1Feinberg School Of Medicine – Northwestern University, Chicago, IL, USA 2Northwestern University, Department Of Surgery, Division Of Vascular Surgery, Chicago, IL, USA 3Saint Louis University School Of Medicine, St. Louis, MO, USA
Introduction: Preoperative patient education is associated with improved disease knowledge, increased procedural understanding during the informed consent process, enhanced shared decision making, and decreased patient anxiety and postoperative complications. Poor disease and procedural knowledge have been reported among patients with peripheral artery disease (PAD) and abdominal aortic aneurysm (AAA). The objectives of this systematic review and meta-analysis were to summarize the preoperative patient education interventions used in vascular surgery and determine their impact on patient understanding of their surgical procedures.
Methods: Embase, PubMed, and Ovid (MEDLINE) were searched in accordance with PRISMA guidelines. Included studies addressed a vascular specialty-specific procedure with an educational intervention and included patient knowledge as a key outcome variable. Using pre- and post-educational intervention mean knowledge scores for experimental and control groups, a forest plot with standardized mean difference (SMD) was generated. Sub group analyses were performed for patients undergoing AAA repair and for interventions using decision aids.
Results: A total of 6 studies were identified (5 randomized controlled trials and 1 prospective cohort study). A total of 654 patients were studied (mean age 66±9.9 years; 68% male) with procedures including open and endovascular AAA repair, femoral-popliteal bypass, carotid surgery, and endovenous thermal ablation. Educational interventions included verbal and written informed consent discussions, online and written decision aid tools, 3D and virtual reality (VR) displays, and a multimedia interactive digital health education tool. Across the 6 included studies, the SMD was 0.64 (95% CI, 0.48-0.79), suggesting a significant, moderately positive effect of educational interventions on patient knowledge. For AAA repair and decision aid subgroups, 4 papers were included in each analysis. Both analyses yielded significant results with a SMD of 0.58 (95% CI, 0.42-0.75) and 0.62 (95% CI, 0.45-0.79), respectively.
Conclusion: Online, written, and multimedia patient education tools including decision aids, 3D and VR displays, and videos have been utilized to improve patient knowledge in vascular surgery. Preoperative patient education, especially decision aids, can enhance understanding of operative interventions. Continuing to develop and implement procedure-specific and patient-oriented education interventions is essential to address knowledge gaps among patients undergoing surgery for vascular diseases.