Pre-Operative Education in Breast Surgery, A Quality Improvement Project

Effective patient education before surgery is a critical component of care that impacts patient outcomes, satisfaction, and overall surgical success. Lack of standardization of this education and prolonged time between pre-operative consults and surgery could result in inadequate patient knowledge on the day of surgery and subsequent uncertainty, anxiety, and poor adherence to post-operative instructions or delays in accessing adjuvant care. This project aims to address this concern by implementing a standardized pre-operative video visit focused on patient education before upcoming breast surgery.

Patients undergoing breast surgery in a comprehensive cancer center at a tertiary academic center were enrolled. Pre-operative video visits were conducted by a Nurse Navigator (NN) one week before surgery. The NN covers logistical information about the surgery, addresses any missing orders, schedules needed postoperative appointments, addresses potential scheduling issues, and answers patient questions. Two validated surveys were administered anonymously to evaluate the effectiveness and impact of this preoperative visit: The state-trait anxiety inventory (STAI) and short assessment of patient satisfaction (SAPS). The STAI was administered before and after the visit. The Wilcoxon signed-rank test and unpaired t test were used to conduct comparative analysis of the pre- and post-appointment STAI values. Analysis was conducted on the overall anxiety score and scores for each individual question.

In total, 50 patients completed the SAPS, 69 completed the pre-visit STAI, and 59 completed the post-visit STAI. There was no statically significant difference between the overall STAI score [mean (standard deviation)] before [34.71 (10.5)] versus after [34.56 (11.4)] the visit (p = 0.8) (Figure 1). However, there were p-values below 0.2 for two STAI questions and between 0.2-0.3 for two others (Table 1). When considering trends with a p-value below 0.2, patients felt more secure and pleasant after the visit. When considering trends with a p-value below 0.3, patients felt less frightened but more nervous after the visit. All patients felt satisfied (12%) or very satisfied (88%) with the effect of the preoperative visit, and other SAPS markers of satisfaction were similarly high (Table 2).

This educational initiative offers a quality improvement solution to standardizing patient education before breast surgery. Measures of patient satisfaction following the appointment were high, however the impact on anxiety levels remains nuanced. These finding highlight the complexity of pre-operative emotions that patients may experience as their breast surgery date approaches.