Barnett - systematic review of patient satisfaction measures in anaesthesia and perioperative care

27 Pages·2013·0.46 MB·English

Review ARTiCle
David S. Warner, M.D., Editor
Patient-Satisfaction Measures in Anesthesia
Qualitative Systematic Review
Sarah F. Barnett, M.B.B.S., B.Sc., F.R.C.A.,* Ravi K. Alagar, M.B.C.H.B., F.R.C.A.,† Michael P. W.
Grocott, B.Sc., M.D., F.R.C.A., F.R.C.P., F.F.I.C.M.,‡ Savvas Giannaris, D.E.S.A., F.F.I.C.M.,* John R.
Dick, M.B.B.S., F.R.C.A.,* Suneetha Ramani Moonesinghe, B.Sc., F.R.C.A., M.R.C.P., F.F.I.C.M.§
* Centre for Anaesthesia, University College Hospital, London, ABSTRACT
United Kingdom, and Consultant in Anaesthesia, University Col-
lege London Hospitals NHS (National Health Service) Foundation
Trust, London, United Kingdom. † Centre for Anaesthesia, Univer-
Patient satisfaction is an important measure of the quality
sity College Hospital, and Locum Consultant in Anaesthesia, Hex-
ham General Hospital Northumbria NHS Trust, Hexham, United of health care and is used as an outcome measure in inter-
Kingdom. ‡ Centre for Anaesthesia, University College Hospital; ventional and quality improvement studies. Previous studies
Professor of Anaesthesia and Critical Care Medicine, University of
have found that there are few appropriately developed and
Southampton, Southampton, United Kingdom; Consultant in Criti-
cal Care Medicine, University H ospital Southampton NHS Founda- validated questionnaires available. The authors conducted
tion Trust, Southampton, United Kingdom; and Director, National a systematic review to identify all tools used to measure
Institute of Academic A naesthesia Health Services Research Centre
patient satisfaction with anesthesia, which have undergone a
and British Oxygen Company Professor of Anaesthesia, Royal Col-
lege of Anaesthetists, London, United Kingdom. § Consultant and psychometric development and validation process, appraised
Honorary Senior Lecturer in Anaesthesia and Critical Care Medi- the quality of these processes, and made recommendations
cine, University College London Hospitals NHS Foundation Trust;
of tools that may be suitable for use in different clinical and
Director, UCL/UCLH Surgical Outcome Research Centre (SOuRCe),
Department of Applied Health Research, University College Lon- academic settings. There are a number of robustly developed
don, London, United Kingdom; and Centre for Anaesthesia, Univer- and subsequently validated instruments, however, there are
sity College Hospital.
still many studies using nonvalidated instruments or poorly
Received from the University College London/University Col-
developed tools, claiming to accurately assess satisfaction
lege London Hospital (UCL/UCLH) Surgical Outcomes Research
Centre, University College Hospital, London, United Kingdom. Sub- with anesthesia. This can lead to biased and inaccurate
mitted for publication September 13, 2012. Accepted for publication results. Researchers in this field should be encouraged to use
March 26, 2013. Funded in part by the University College London
available validated tools, to ensure that patient satisfaction is
Hospital, University College London Biomedical Research Centre,
London, United Kingdom (to Dr. Moonesinghe), which received measured and reported fairly and accurately.
a portion of its funding from the United Kingdom Department of
Health’s National Institute of Health Research Biomedical Research P ATIENT satisfaction is an important measure of the
Centre funding scheme, London, United Kingdom. Dr. Grocott
holds the British O xygen Company Chair of Anaesthesia at the quality of health care. Satisfaction with a nesthesia
Royal College of Anaesthetists, London, United Kingdom. Funded is used as an outcome measure in clinical trials,1 and
in part by the University Hospitals Southampton National Health
patient satisfaction is considered to be an integral part of
Service Foundation Trust, University of Southampton Respiratory
Biomedical Research Unit, Southampton, United Kingdom (to Dr. service quality.2 Its measurement is also required to fulfill
Grocott), which received a portion of its funding from the United performance improvement and revalidation agendas for
Kingdom Department of Health’s National Institute of Health healthcare professionals.3 However, clinical experience tells
Research Biomedical Research Unit f unding scheme. Dr. Grocott is
Director, and Dr. Moonesinghe is a member of the Executive Board us that appropriately developed or validated instruments are
of the National Institute for Academic Anaesthesia’s Health Services not widely used in any of these settings.
Research Centre. Drs. Grocott and Moonesinghe serve on the Board
and Research Council of the National Institute for Academic Anaes-
thesia. Drs. Grocott and Moonesinghe have received funding from [email protected]. This article may be accessed
the National Institute of Health Research, the National Institute of for personal use at no charge through the Journal Web site,
Academic Anaesthesia, and the Frances and Augustus Newman www.anesthesiology.org.
Foundation to conduct Health Services Research.
Address correspondence to Dr. Barnett: Centre for Anaesthesia,
3rd Floor, Maples Link Corridor, University College Hospi- ◆ This article is accompanied by an Editorial View. Please see:
tal, 235 Euston Road, London, United Kingdom, NW1 2BU. Vetter TR, Ivankova NV, Pittet J-F: Patient satisfaction with an-
esthesia: Beauty is in the eye of the consumer. ANESTHESIoloGy
Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott 2013; 119:245–7.
Williams & Wilkins. Anesthesiology 2013; 119:452–78
Anesthesiology, V 119 • No 2 452 August 2013
EDUCATION
Pascoe4 defined patient satisfaction as the patient’s are described in table 1. In the “satisfaction” field there is no
reaction consisting of a “cognitive evaluation” and “emotional “definitive standard” to compare with (criterion validity),
response” to the care they receive. It, therefore, seems prudent so to guarantee validity of the questionnaires, a thorough
to ensure that patients are involved in the development of item-generation process is required to ensure content and
satisfaction tools, particularly because it is also subject to the face validity. Results can then be correlated with other
sociodemographic, cultural influences, and cognition of the factors suspected to be associated with the topic, known as
patients.5 The Picker inpatient survey6 is a well-known tool construct validity. Measuring the internal consistency of the
used in Europe to measure “patient experience,” however, there questionnaire may also enhance the validity. Items within a
have been many flaws detected in its design, including the lack dimension should correlate, and the individual dimensions
of patient involvement in the development stage.7 This has should have a Cronbach α greater than the overall result.10
been compared with the Hospital Consumer Assessment of Quality of recovery11 is sometimes joined with patient
Healthcare Providers and Systems survey used by Press Ganey satisfaction and quality of life to provide “patient-centered”
in the United States, which has been extensively developed.8 outcomes.5 Previous work has comprehensively reviewed
The development of a patient-satisfaction tool requires a the literature on quality-of-recovery scores12,13 and found
step-wise psychometric process and subsequent validation there to be at least two suitable instruments available. How-
in practice, and due to the multidimensional and complex ever, systematic evaluations of instruments used to measure
nature of satisfaction, questionnaires should use multiple patient satisfaction after anesthesia, have been limited to
items to investigate specific events.9 The steps generally two particular clinical settings: ambulatory anesthesia14 and
involved in the psychometric development of a questionnaire regional anesthesia;15 both reviews demonstrated a paucity
Table 1. Psychometric Construction and Evaluation of a Questionnaire1,5
Item generation and dimensions Involves gathering the opinions of patient-focus groups, anesthetists,
and reviews of the current literature, to define items that are considered
significant. These items are then divided into separate dimensions, with the
subsequent development of a pilot questionnaire.
Testing of pilot questionnaire The pilot questionnaire is then tested to assess its reliability, validity, and ease
of understanding. At this stage, a number of items may be removed, if found
to be ambiguous or superfluous.
Retesting of pilot questionnaire The pilot questionnaire is then retested in another group of patients in the form
of face-to-face interviews, written mail, and/or telephonic questionnaires.
Biases related to sociodemographic status, social desirability (answering
the questions in order to please the investigator, rather than giving their true
opinion), and nonrespondent bias can all be addressed.
Validity Multifaceted concept. Includes content validity, which ensures that the
important components regarding satisfaction are included, and face validity,
where the assessors ensure that the items measure what they are intended
to. Criterion validity assesses the new measure against a current definitive
standard. Construct validity asks whether the questions are constructed
to ensure a valid result and includes convergent and discriminant v alidity.
Convergent validity describes correlation with other factors measuring
similar aspects, whereas discriminant validity should ensure that dissimilar
factors are not correlated.
Reliability Reliability is the consistency of results. Internal consistency is measured using
Cronbach α, which is a value correlating the items, ensuring that they all
measure the same thing within a dimension. If the Cronbach α is 0, there
is no correlation between the questions, and the maximum possible value
is 1. The result should be between 0.7 and 0.9. If the value is >0.9, it may
indicate that the questionnaire is too small in range. Test–retest reliability is
when the test is performed on the same patient on >1 occasion. The cor-
relation coefficient of the test results should be >0.7. Inter- and intrarater
agreements are how accurately different observers agree with each other,
and how accurately the same observer agrees over time, respectively.
Acceptability Measures of acceptability include the time to complete the questionnaire and
the response rate. Different routes of administration of the q uestionnaire
can affect the response rate,84 which may also affect the validity of the
questionnaire. Nonresponder bias deals with the potential differences
between those who are highly satisfied and those who are poorly satisfied,
and their participation in answering the questionnaire.5
Retest “final” questionnaire in new This provides further assessment of validity and reliability, and reassesses
patient samples confounding variables.
Anesthesiology 2013; 119:452-78 453 Barnett et al.
Patient-Satisfaction Measures in Anesthesia
of appropriately validated tools. To our knowledge, there evaluation process by assessing how the authors reported
is no published evidence synthesis of instruments used to the questionnaire development process, pilot testing,
measure patient satisfaction with anesthesiology in general. and the validity, reliability, and acceptability of each
Given the importance of using validated outcome measures, instrument. The criteria we have used for assessing validity
and the increasing focus on patient-centered outcomes in is based on methodological descriptions of thorough item
both research and clinical practice, this represents an impor- generation as well as authors claims. We were unable to
tant gap in the literature. Therefore, we have undertaken find a published system for comparing the quality of the
a qualitative systematic review, to answer the question: psychometric development processes for questionnaires
“What instruments have been psychometrically developed in a structured and objective manner. Therefore, we have
to measure patient satisfaction with anesthesia, and what is reported our evaluation of the psychometric development
their validity?” The purpose of this review is to q ualitatively reported in each article, by dividing the process into three
appraise the literature and provide guidance about the phases: (1) item generation and pilot testing, (2) validation
strengths and limitations of patient-s atisfaction tools that and reliability, and (3) acceptability to patients, including
may be used for quality improvement and research purposes. response rate and completion time. Each questionnaire was
then scored on a scale of 0 to 2 in each category, with a
Methods maximum achievable score of 6. Although this scoring
system was not previously validated, it gives an indication of
We have adhered to the Preferred Reporting Items for
the depth of psychometric development and testing behind
Systematic Reviews and Meta-Analyses statement standards
each questionnaire.
in this article.16
Data Sources
Results
We searched the online databases MEDLINE and Embase
The search identified 18,665 studies. Two authors
and ISI Web of Science (all database search) for articles pub-
independently screened the titles and abstract, and 15,454
lished between January 1, 1980 and March 1, 2012 without
articles were excluded. Three authors reviewed the full texts
language exclusion, but limited to human studies. The search
of the remaining 3,211 articles; manual searching of reference
strategy included snowballing of references and manual
lists (snowballing) revealed a further 58 articles. Articles that
searching of citation lists, which is detailed in appendix 1.
excluded were 3,118 as they did not describe instruments that
Inclusion/Exclusion Criteria met our definition of a patient-satisfaction questionnaire. Of
For the purposes of this review, a “patient-satisfaction ques- the remaining 150 articles, 79 were excluded as they did not
tionnaire” was defined as an instrument that was developed use a questionnaire which met our criteria for psychometric
using psychometric techniques, and that consisted of at least development. Therefore, our final analysis consists of 71
two distinct dimensions. We included all studies that used a articles describing a total of 34 patient-satisfaction scores,
questionnaire developed in this way to assess patient satisfac- developed and evaluated using psychometric testing (fig. 1).
tion with some aspect of anesthesia: these included studies Questionnaires meeting our inclusion criteria were not
of pediatric patients and parental satisfaction, satisfaction published before 1990, however, 6 were from the 1990s, and
with general anesthesia, local anesthesia, ambulatory anes- 28 were between 2000 and 2012 March.
thesia, and regional anesthesia. In order to avoid repeating Our description of the original articles developing each
previously published work, we have focused on measures of of these 34 patient-satisfaction tools is listed by clinical
“patient satisfaction” and therefore, have excluded s tudies specialty in tables 2–7. We have reported the details of the
describing the development or validation of “quality of psychometric evaluation process and scored the presence of
recovery” indicators. We also excluded questionnaires that item generation, validity and reliability, and acceptability
were developed to measure satisfaction with sedation or sat- for each of these studies in table 8. A list of studies which
isfaction solely with pain management. have subsequently used any one of these 34 questionnaires is
provided in appendix 2. Below, we report a summary of the
Data Extraction overall results and descriptions of the highest quality studies
We reported the characteristics and quality of every article in each category.
by extracting the following information: year and country
of origin, number of patients recruited into study, number Maternal Satisfaction (table 2)
of dimensions within the score, number and nature of the We found three studies, which used questionnaires that
items within each dimension, the response format, the type had been psychometrically developed to measure maternal
of anesthesia and surgery being evaluated, and the results of satisfaction with obstetric care: two were used follow-
the study as reported by the authors. ing cesarean section, and one assessed maternal satisfac-
For every satisfaction measure we identified, we evaluated tion after neuraxial blockade for labor analgesia. Of these,
the rigor of the original psychometric construction and one17 involved patients in the questionnaire design and
Anesthesiology 2013; 119:452-78 454 Barnett et al.
EDUCATION
Total number of citations screened
18,665
Reviewed in detail for inclusion
3211
Exclusion due to single response
Papers identified through snowballing
/binary answers or quality of
recovery 58
3118 Papers using inclusion criteria for
satisfaction questionnaire
150
Excluded (questionnaires not
psychometrically developed)
79
Inclusion in final analysis (Original articles) Papers referencing one of the 34
questionnaires which had been
34 psychometrically developed
Perioperative 23 37
Paediatric 6
Maternal 3
Monitored Anaesthetic Care1
Regional 1
Fig. 1. Flowchart demonstrating systematic review process.
development process and two did not.18,19 Morgan et al.17 Monitored Anesthetic Care (table 4)
used a clearly defined psychometric development and The American Society of Anesthesiologists defines Monitored
evaluation process, a 22-item questionnaire, which they Anesthetic Care as the delivery of local anesthesia together
named the Maternal Satisfaction Scale for Cesarean Sec- with sedation and analgesia for a planned procedure.
tion. Hobson et al.20 validated the Maternal Satisfaction The most referenced instrument assessing satisfaction with
Scale for Cesarean Section using a different distribution Monitored Anesthetic Care is the Iowa Satisfaction with
format to the original development article; Sindhvananda Anesthesia Scale (ISAS), consisting of 11 questions;24 this
et al.18 used the most objectively robust development and scored highly (6 out of 6) in our objective appraisal of the
validation process (scoring 5 out of 6 on our assessment); development process.
however, their report was published in 2002,21 and their We found a further 17 studies using the ISAS to assess
questionnaire has not subsequently been used in any other satisfaction. Eight of these used the ISAS for satisfaction
published studies. with ophthalmology procedures;25–32 only one of these
studies28 performed further validation of the scale within
Regional Anesthesia (table 3) their patient cohorts. The remaining studies used the ISAS
Although there were many studies which included s atisfaction to assess satisfaction with Monitored Anesthetic Care for
with general and regional anesthetics, we could find only one other procedures and surgery.33–37,38–40
French article, which used a psychometric d evelopment and
evaluation process, to construct a questionnaire m easuring Pediatrics (table 5)
satisfaction with regional anesthesia in the nonobstetric We identified six tools used in pediatric anesthesia,
setting.22 Despite a growing literature evaluating the efficacy which had undergone psychometric development.41–46
and outcomes of regional anesthesia, this instrument has Kain et al.44 developed an 11-item questionnaire using a
subsequently been used in only one other study.23 This lack three-step approach starting with validity testing in the
of validated tools for measuring satisfaction with regional form of items grouping using input from anesthetists, sur-
anesthesia was also reported by Wu et al.15 in their systematic geons, psychologists, play specialists, and nurses. A rig-
review of this field of practice. orous protocol and psychometric evaluation was recently
Anesthesiology 2013; 119:452-78 455 Barnett et al.
Patient-Satisfaction Measures in Anesthesia
Questionnaires Developed to Measure Satisfaction in Obstetric Anesthesia Country No. of No. of No. of of OriginTool Questions DimensionsDimensionsResponse FormatPatientsSurgeryAnesthesiaResults 115Cesarean RegionalDevelopment of valid, Interview, pre- and 224Communication and CanadaMSSCS 22 sectionreliable, maternal-satis- postprocedure control, anesthetic items—7-faction scale for women (for item genera-effects, postoperative point Likert tion only) undergoing nonemer-scaleproblems, side gency cesarean sectioneffectsInterview in PACU 114Elective Spinal or Validation of scale to ThailandQuestion-114Procedure, or ward 24–48 h cesarean epiduralassess patient satisfac-naire,11 hypoten sion, after surgerysectiontion with regional for items, 0–10 postoperative cesarean sectionVASevents, and quality of anesthesia1 day after delivery90Labor Epidural Minimal steps taken 446Pain, control, relation-FinlandQuestionnaire, analgesiaPCEA vs. to ensure a valid tool to ship with spouse, 44 items, bolusassess patient satisfac-fears, and expecta-pain VAS at tion with labor analgesiations, emotions after three stages delivery, physical con-of labor, dition after delivery4-point Likert scale aternal Satisfaction Scale for Caesarean Section; PACU = postanesthetic care unit; PCEA = patient-controlled epidural analgesia; VAS = visual analog scale. Questionnaires Developed to Measure Satisfaction with Regional Anesthesia No. of No. of Dimensions Patients Country Ques-No. of (No. of Questions Response Initially of OriginTooltions Dimensionsin Each)FormatRecruitedSurgeryAnesthesiaResults Local/regional Develop-314Orthope-Telephonic 3Information, pain, Seven FranceQuestionna-anesthesia ± ment and dics and interview day and anxiety questions ire, 2 institu-sedation validation trauma, ele-1 and day 8 during proce-day 1. tionsof a patient ctive, day by pharma-dure, overall Nine Seven ques-question-case, or cist student satisfaction. questions tions day 1. naire to emergencynot involved Side effects day 8Nine ques-assess in careincluded tions day 8, satisfaction in day-8 open-ended with regional questionnaireand Likertanesthesia
a M
Table 2. Author Morgan 17et al. Sindh-vanand18et al. Nikkola 19et al. MSSCS = Table 3. Author Monte-negro 22et al.
Anesthesiology 2013; 119:452-78 456 Barnett et al.
EDUCATION
sthesiaResults MACDevelopment of reliable, inter-nally consistent, and valid meas-ure of patient satisfaction with MAC (not the perioperative experience) etic care unit. hesiaResults Assessed pediatric parental anxiety and satisfac-tion with overall theatre care, which included anesthe-sia. Educational program improves satisfaction and anxiety for parents. (Continued)
No. of Patients nitially RecruitedSurgeryAne 94Inpatient and day surgery. Ophthal-mology, plastics, brain biopsy, GI, ENT, orthope-dics, gynecology d Anesthetic Care; PACU = postanesth d/or Parental) No. of Patients Initially RecruitedSurgeryAnest GA50 Pediatric parents(aged 1–9), elective urology, hernia, ENT, plastic surgery
Measure Satisfaction with MAC No. of Dimensions Dimen-(No. of Questions in INo. of Response QuestionssionsEach)Format Written, 15 min 11No specific Nausea and vomiting, after phase domainssame anesthetic 2 PACU, again, itch, relaxed, some also pain, safe, com-repeated fort/temperature, within 1 h satisfaction with or the next anesthetic care, pain morning during surgery, felt good, hurt nal; ISAS = Iowa Satisfaction with Anaesthesia Scale; MAC = Monitore Measure Satisfaction with Pediatric Anesthesia Care (Patient an No. of No. of Dimensions (No. of Response Questions DimensionsQuestions in Each) Format NANo specific Opinion of parental 18 ques-dimension presence on tions, 1–5 induction, visita-Likert scale tion in recovery, plus overall performance satisfaction of operating rated 0–10staff- adequacy, relevancy, and understanding of information
naires Developed to Tool ISAS, 11 ques-tions – 6-point Likert scale (bipolar, symmetrical summated rat-ing scale) hroat; GI = gastrointesti naires Developed to Tool Parental Satisfac-tion with Care questionnaire (translated from Chinese)
Question Country of Origin United States ose, and t Question Country of Origin China
n
Table 4. Author Dexter 24et al. ENT = ear, Table 5. Author Chan et 41al.
Anesthesiology 2013; 119:452-78 457 Barnett et al.
Patient-Satisfaction Measures in Anesthesia
esults arents preferred shared decision-making with the anesthetist. Instru-ment developed to measure parental satisfaction with decisions regard-ing pediatric anesthesiaevelopment and validation of ques-tionnaire to meas-ure parental and child satisfaction (Continued)
R P D
a
si
e
h
st A A
e G G
n
A
urgery ediatrics elective ediatric, inpatients (aged 23 days to 15 yr), minor abdominal or genitor- urinary
S P P
d
No. of Patients nitially Recruite 331 214
IDimensions (No. of Response Questions in Each) Format Preferences (11), Telephone concerns (11), interview satisfaction (8) day 1 post-operatively Written, on Quality of commu-return to nication, quality ward post-of environment, procedure quality of care by anesthetists, parental opinion of child’s recollection, parental opinion of overall experience, parent (dialog, comfort in environ-ment, affection and care by nurses, quality of anesthe-tists observation postop, emo-tional judgment, child (preop fear, anesthetists’ effect on fear, operating room, induction, calming effect of anesthetists on induction, pres-ence of pleasant staff, and disturbing objects, greatest anxiety)
s
n
o
si
of en 3 5
o. m
NDi
No. of Questions 30 questions, 5-point and 4-point Likert scale responses and VAS for anxiety and overall satisfaction 6 questions for parent, 9 questions for children
o-e
d) Tool Questionnaire Questionnaire, 2 parts; parent —6 item, 10-point Likert scale; child—9 items, 8 dichotmous, 1  multiplchoice
(ContinueTable 5. Country Authorof Origin 42Tait et al.United States Iacobucci Italy43et al.
Anesthesiology 2013; 119:452-78 458 Barnett et al.
EDUCATION
esults ssessment of parental satis-faction. Parents who accompany children to operat-ing room were less anxious and more satisfied. Paren-tal satisfaction significantly higher in cases where premedication usedevelopment and validation of pediatric endos-copy service satis-faction instrument sychometric ques-tionnaire to assess pediatric patient satisfaction with anesthetic care
R A D P
nesthesia NA A (<10 yr old) IV sedation GA/RA
A G
Surgery Pediatrics (aged 2–8) Pediatrics (aged 1 month to 19 yr), gastroscopy and colonoscopy Pediatrics, elective, minor to major surgery al analog scale.
u
No. of Patients Initially Dimensions (No. of Response Questions in Each) FormatRecruited 103Written, on Overall satisfaction discharge with function of from children’s hospital, recovery, surgery center, 2 weeks anesthesiologists, postopera-surgeons, and tivelynurses. Overall satisfaction with quality of separa-tion process 157Parents and State of information, patients. organizatio nal Written first issues, anxiety, part during pain, and discom-waiting fort, and medica-time for tion side effects procedure. Second part after procedure and before discharge1,0526–48 h after Treatment of returning discomfort (7), to ward. privacy/waiting Postal (10), information return giving (7), discom-or col-fort (9), treatment lected by pain (4)research assistant not applicable; RA = regional anesthesia; VAS = vis
No. of Dimensions No spec ific doma ins 5 5 venous; NA =
o. of uestions 21 questions 23 questions 37 hesia; iv = intra
N Q st
e
d) Tool Questionnaire, 21 item—5 cm VAS Questionnaire, 23 items, dichot-omous and free-text responses Pediatric perianesthesia questionnaire hroat; GA = general an
Continue Country of Origin United States Canada Germany ose, and t
( n
able 5. uthor ain 44et al. hour 45et al. chiff 46et al. NT = ear,
T A K K S E
Anesthesiology 2013; 119:452-78 459 Barnett et al.
Patient-Satisfaction Measures in Anesthesia
Results Modified Delphi proce-dure to construct the questionnaire. Anxiety measures validated, but unknown reliability and validity for meas-ures of preoperative visit. Overall preop visit satisfaction: 78–79%. Training anesthetists in communication skills can improve patient satisfaction with preop visits (not significant)To assess whether a Web site enhances information acquisition, influences preoperative anxiety and overall patient satisfaction. No significant difference was found Feasibility study of previ-ously validated tool used in other clinical settings. Measure of communi-cation and empathy of clinical consultation and not technical skills. May have use in anestheticsDevelopment and valida-tion of a preassessment satisfaction questionnaire
Anes-thesia NA GA NA Preas-sess- ment
-
urgery NA ctive, ay urgery NA neral nd vasular
S eds eac
El G
No. of Patients Initially Recruited 1,338 64 1,582 104 ale.
Response Format Written, up to 3 months pre- and postop Before discharge Written, immediately after pre-operative assessment anesthetist consultation Written, inpatient, evening of preas-sessment (before premedica-tion) = visual analog sc
ssessment Dimensions (No. of Ques-tions in Each) Preop visit, patient preop anxi-ety, percep-tion of anes-thetist Satisfac-tion with preoperative anesthetic experience Pre-op assessment consultation Patient satisfaction (6) and information gained (6) ot applicable; VAS
a s n
n with Pre No. of Dimension 3 NA NA 2 esia; NA =
o h
cti s est
Satisfa No. of uestion 86 NA 10 12 neral an
es Developed to Measure Tool Q Questionnaire, 86 items, 11 items on 6-point scale for preop visit satisfaction, Spielberger-State— Anxiety Score, 12 items using 10-cm VAS for preop anxiety NA CARE measure, 10 items, 5-point Likert scale Questionnaire evalu-ating preanesthetic visit, 12 questions6-point scale (−3 to +3) or 4 multiple-choice questions Relational Empathy; GA = ge
uestionnair Country of Origin witzer-land nited States nited Kingdom ermany ultation and
Q S U U G s
n
Table 6. Author Harms 85et al. Hering 86et al. Mercer 50et al. Snyder-Ramos 48et al. CARE = Co
Anesthesiology 2013; 119:452-78 460 Barnett et al.
EDUCATION
Results Informa-tion booklet increases satisfaction with preanesthetic visit Initial construction and validation study for EVAN-G questionnaire Final psychomet-ric validation of EVAN-G questionnaire (highest score in discomfort, lowest score in informa-tion, signifi-cantly greater satisfaction scores for patients aged > 65 yr)A valid question-naire used for either a stand-ardized inter-view or written questionnaire. Questions answered in a more critical manner during an interview, improving quality control (Continued)
n
nesthesia GA A ± regional A (exclusioof MAC and regional anesthe-sia) GA
A G G
urgery ective, gastrointestinal, urology, orthopedic, ophthalmology, neurosurgery, ENT, dental, othersective non–day-case surgery mixed (except obstet-rics)ynecological, GI, orthopedic, ENT, vascular, endocrine, endoscopic, aesthetic, urology, neurosurgical, maxillofacial, ophthalmology, thoracic, day case ective inpa-tient, general, vascular, trauma, urol-ogy, ENT, gynecology
S El El G El
No. of Patients Initially Recruited 176 742 977, multi- center (8 anes-thetic depart-ments) 700
Response Format On discharge, written, mailed back Postop, within 24 h, written Within 48 h, before  discharge, written Postopera-tive day 2, written or stand-ardized personal interview
h Perioperative Care Dimensions (No. of Questions in Each) Structure (8), physi-cian behavior (6), information (5), well-being (6) Anxiety, embarrass-ment, fear, pain discomfort, infor-mation, physical needsAttention (5), privacy (4), information (5), pain (5), discomfort (5), waiting (2) Discomfort (10) and anesthesia care (5)
sfaction wit No. of Dimensions 4 6 + global score 6 + global index 2
ati
S
asure No. of Ques-tions 25 25 26 15
es Developed to Me Tool Questionnaire, 25 questions 5-point Likert scale Questionnaire—EVAN 25 ques-tions 0–100 scale Questionnaire—EVAN-G 26 questions, 5-point Likert scale scores transformed into 0–100 scale for satisfaction 15-item written questionnaire vs. face-to-face interview. Semidi-chotomous scale or 4-item scale
uestionnair Country of Origin France France France Germany
Q
o
Table 7. Author Albaladej87et al. Auquier 51et al. Auquier 62et al. Bauer 63et al.
Anesthesiology 2013; 119:452-78 461 Barnett et al.