Randomized Controlled Trial: Evaluation of Multifaceted Preoperative Patient Education on Anxiety, Delirium, Knowledge and Patient Satisfaction among Post-Pulmonary Thromboendarterectomy Patients

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Note: The co-author of this thesis is Cassia Chevillon. See the attached thesis cover page.

Full Abstract: This prospective, randomized controlled trial was conducted to evaluate the impact of multifaceted preoperative patient education on anxiety, knowledge, satisfaction, and postoperative delirium, and to explore the predictors of delirium, mechanical ventilation, and intensive care unit (ICU) length of stay. Consented patients undergoing pulmonary thromboendarterectomy from October 2011 to April 2013 were randomized in 1:1 ratio to receive either an individualized 45-minutes multifaceted preoperative education (experimental group, n=63) or standard education (control group, n=66). Participants completed knowledge Test and the State-Trait Anxiety Inventory before and after the education. Patient satisfaction, delirium, mechanical ventilation, ICU length of stay, and cardiopulmonary parameters were collected. The experimental group had significant improvement in postoperative care knowledge (p<0.001) and fewer days on mechanical ventilation (p=0.038) compared to the control group. No statistically significant differences were observed in anxiety, satisfaction, length of ICU stay, and incidence of delirium. In exploratory multivariate analyses, hearing impairment was a statistically significant positive predictor for days of delirium (p=0.009), days of mechanical ventilation (p<0.001), and ICU length of stay (p=0.049); whereas the posttest knowledge was a statistically significant negative predictor for days of mechanical ventilation (p=.018). The multifaceted preoperative patient education appeared to be effective in improving knowledge, lowering incidence of delirium, and reducing days of mechanical ventilation. Hearing impairment was an unexpected negative predictor of patient outcomes, which may be amenable to nursing intervention.

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