Information needs of patients in spine surgery: development of a question prompt list to guide informed consent consultations

BACKGROUND CONTEXT

Informed consent is mandatory before surgery and fundamental in the physician-patient interaction. However, communication is sometimes suboptimal.

PURPOSE

The objective was to develop a question prompt list (QPL) for patients undergoing spine surgery (spinal neurosurgery-QPL, “SN-QPL”) to encourage them to acquire information during the informed consent consultation (ICC) and assess patients’ information needs.

STUDY DESIGN/SETTING

We conducted a prospective uncontrolled single center study in order to develop a QPL for patients undergoing spine surgery.

PATIENT SAMPLE

Patients inclusion criteria were as follows: (1) planned spinal surgery, (2) age 18 to 80 years, (3) legal capacity, (4) ability to understand and respond to questionnaires, and (5) informed consent.

OUTCOME MEASURES

We applied the following self-report measures: the developed preliminary QPL with regard to surgery topics and assessment of patients’ information needs.

METHODS

First, we performed a literature review, patient interviews, and two expert rounds. Subsequently, we validated a preliminary SN-QPL including 37 items before and after ICC with regard to importance of items and fulfillment of information needs in 118 patients. A principal component analysis followed by varimax rotation revealed the final SN-QPL.

RESULTS

For the final version of the SN-QPL, 27 items with following four reliable subscales were derived with satisfactory internal consistency: (1) scale SN-QPL-C, “complications and possible postoperative deficits” (n??=??8 items, Cronbach α?=?0.88); (2) scale SN-QPL-P, “prognosis and follow-up” (n?=?8 items, Cronbach α?=?0.86); (3) scale SN-QPL-I, “preoperative inpatient stay and organizational issues” (n?=?5 items, Cronbach α?=?0.75); and (4) scale SN-QPL-S: “safety of the surgical procedure” (with n?=?6 items, Cronbach α?=?0.84). The most unmet information needs were found in SN-QPL-P. The item with the greatest unmet information needs was “How much professional experience does my surgeon have?”

CONCLUSIONS

Our SN-QPL was well-accepted and perceived as helpful by patients awaiting spinal surgeries. It seems to address meaningful items and questions. It could therefore be useful in optimizing pre- and postoperative satisfaction. Further, our study identified many unaddressed questions warranting communication interventions.