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ORIGINAL SCIENTIFIC REPORT
Preoperative Needs-Based Education to Reduce Anxiety, Increase
Satisfaction, and Decrease Time Spent in Day Surgery:
A Randomized Controlled Trial
Apinut Wongkietkachorn
1
•Nuttapone Wongkietkachorn
1
•Peera Rhunsiri
2
ÓSocie
´te
´Internationale de Chirurgie 2017
Abstract
Background Too much or too little information during patient education can increase patient anxiety. Needs-based
patient education helps to determine the appropriate amount of information required to provide education based on
patient needs. This study aimed to compare needs-based patient education with traditional patient education in
reducing preoperative anxiety.
Methods This was a prospective, multicenter, single-blind, randomized controlled trial with a 1:1 allocation ratio.
Patients undergoing day surgery were randomized into a study group (needs-based education) or a control group
(traditional education). The primary outcome was patient anxiety. Secondary outcomes were patient satisfaction and
time spent in patient education. Patients completed questionnaires to evaluate their anxiety and satisfaction before
patient education, after patient education, and after surgery.
Results In total, 450 patients were randomized and analyzed (study group n=225, control group n=225).
Comparisons before education, after education, and after surgery showed that there was a significant decrease in
patient anxiety and an increase in satisfaction in both groups (p\0.001). The comparison between needs-based
education and traditional education showed a greater decrease in anxiety (7.09 ±7.02 vs. 5.33 ±7.70, p=0.001)
and greater increase in satisfaction (21.1 ±16.0 vs. 16.0 ±21.6, p\0.001) in the needs-based group. The needs-
based group also had significantly less education time than the traditional group (171.8 ±87.59 vs.
236.32 ±101.27 s, p\0.001).
Conclusion Needs-based patient education is more effective in decreasing anxiety, increasing patient satisfaction,
and reducing time spent in education compared with traditional patient education.
Trial registration ClinicalTrials.gov, number NCT03003091
Introduction
Preoperative anxiety can compromise surgical outcomes
[1]. Anxiety increases serum cortisol, adrenaline, and
noradrenaline [2,3]. This results in postoperative pain,
increased postoperative analgesic requirements, prolonged
hospital stay, and patient dissatisfaction [4,5]. However,
preoperative anxiety can be reduced [4].
Although patient education is widely used to reduce
operative anxiety [4], some patients become more anxious
after the education [6–8]. This may be explained by the
Meeting presentation: 7th Bozner Symposium of Plastic Surgery,
Bozen, Italy, January, 2017.
&Apinut Wongkietkachorn
apinutme@gmail.com
1
Department of Surgery, Chulabhorn Hospital, 54 Kamphaeng
Phet 6, Talat Bang Khen, Lak Si, Bangkok 10210, Thailand
2
Department of Surgery, Ratchaburi Hospital, Ratchaburi,
Thailand
123
World J Surg
DOI 10.1007/s00268-017-4207-0
different coping styles individual patients use to deal with
their anxiety [9–12]. There are four major coping styles:
vigilant, avoidant, fluctuating, and flexible [1,10–12].
People with a vigilant coping style want extended infor-
mation to reduce anxiety [1,11,12]. Those with an avoi-
dant coping style prefer a minimal amount of information,
as too much causes anxiety [1,11,12]. People with a
fluctuating coping style generally desire a small amount of
information but with greater detail in certain areas [11,12],
and those with a flexible coping style are able to adapt to
whatever information is available [11]. Therefore, if patient
education with extended information is given to people
with an avoidant coping style, they will become more
anxious [1,11,12]. In a previous study, Mitchell (11)
found that 31% of surgical patients in the study population
had an avoidant coping style [11]. This was supported by
Gillies and Baldwin [8], who found that one-third of
patients reported being worried after receiving an infor-
mative booklet. Thus, patient education with different
levels of information that reflects patients’ differing needs
should be developed to respond to all types of coping styles
[1,10,11].
Needs-based patient education is promising, and there is
an increasing amount of supporting literature [13,14]. It
involves a process in which patient needs for information
are assessed prior to providing education. It is based on the
principle of shared decision-making, which is central to
patient-centered care [15]. Needs-based education is also
consistent with adult learning theory, in which learning
should be matched to different individual backgrounds and
needs [16]. A randomized controlled trial conducted to
compare needs-based education with traditional education
in patients with rheumatoid arthritis found that needs-based
education was superior [14]. However, evidence for using
needs-based education in surgery remains little and sug-
gestive [17,18].
This study evaluated the effect of needs-based education
in reducing preoperative anxiety, using a questionnaire to
assess patient needs. After receiving a completed ques-
tionnaire, the physician provides information based on
patients’ identified needs. Both patients and physicians can
benefit from this process [14]. The questionnaire enables
physicians to cut unnecessary information and pay more
attention to the facts that patients need. Less information
needed results in less time spent in patient education ses-
sions. This is particularly important, as the most common
reason for omitting patient education is shortness of time
[19]. Needs-based education can contribute significantly to
the way we educate surgical patients.
Objectives
This study aimed to compare needs-based education with
traditional education in terms of how they affected preop-
erative anxiety, patient satisfaction, and time spent in
education.
Methods
Trial design
This was a prospective, multicenter, randomized controlled
trial. The allocation ratio was 1:1. The study was conducted
and data were analyzed in accordance with the Consoli-
dated Standards of Reporting Trials statement [20]. The
study protocol was reviewed and approved by appropriate
ethics committees. This trial was registered at Clini-
calTrials.gov, number NCT03003091.
Participants
Inclusion criteria were patients aged 18 years or older who
were scheduled for excision of benign mass and were
willing to cooperate with the study. Excision was chosen
because it was one of the most common basic procedures in
day surgery. Exclusion criteria were patients who were
illiterate and could not answer the questionnaire by them-
selves, those with psychiatric disorders, those who under-
went surgery within the previous 6 months, and those with
the possibility of undergoing a major operation after day
surgery. After patients agreed to participate, the study
protocol was explained by the investigators. Written
informed consent was obtained from all participants.
The study was conducted in three hospitals in different
regions in Thailand: Chulabhorn Hospital in Bangkok, Mae
Fah Luang University Hospital in Chiang Rai, and Ratch-
aburi Hospital in Ratchaburi.
Interventions
Patient education occurred before informed consent pro-
cess in this study. Participants were randomized in two
groups: a control group and a study group. As most hos-
pitals provided verbal and written information during
patient education, the control group was set to represent
this method of teaching and was defined as traditional
education. All detailed information was provided to par-
ticipants in this group. On the other hand, the study group
received needs-based education. Participants also received
verbal and written information to control the mode of
information delivery, but the major difference was amount
of information provided to participants. These participants
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123
first received a self-administered questionnaire in which
they could choose how much information they would like
to know in each topic (Fig. 1). After completing the
questionnaire, participants submitted the questionnaire to
their physicians (investigators). The physician then pro-
vided patient education based on participants’ identified
needs. For examples, the study group could choose ‘con-
cise’ in disease information and received name and
characteristics of disease, while the control group had to
receive all information in ‘detailed,’ including name,
characteristics, causes, and possibility of recurrence. Other
examples in every topic are illustrated in Fig. 1. Therefore,
the study group received part or all of the information that
the control group received. It was emphasized to all par-
ticipants in the study group that complications were the
Fig. 1 Needs-based patient education questionnaire
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123
only topic they had to be informed due to ethical issue and
the choice, ‘none,’ was not available (Fig. 1).
Questionnaire development
The needs-based patient education questionnaire was
developed based on previous literature, patient interviews,
and expert consultation [1,10,12,21]. With the aim of
reducing anxiety, information was classified into five main
topics: disease information, procedural detail, complica-
tions, patient behavior, and pain [1,12]. Interviews were
conducted with 30 patients to determine what they wanted
to know about these five topics. The results were summa-
rized to make a structured script of preoperative patient
education. The questionnaire was developed based on the
structured script and allowed responders to choose how
much information they wanted about each topic: none,
concise, or detailed (Fig. 1). The questionnaire was piloted
and validated with 20 patients.
To standardize all educators, a structured script was
used to ensure the same amount of information was
delivered to patients. A video recording was used during
standardization to control similarity of educator speaking
speed, intonation, manner, and movement.
Outcomes
The primary outcome was patient anxiety. This was
assessed with the Spielberger State-Trait Anxiety Inventory
(STAI form Y-1: state anxiety) and a 100-mm visual
analogue scale (VAS) for anxiety [22,23]. The STAI was
designed to assess an individual’s momentary or situational
anxiety. It comprises 20 questions, each with four response
options, producing a score between 20 and 80. A higher
score indicates higher anxiety.
Secondary outcomes were patient satisfaction and time
spent in patient education. Patient satisfaction was mea-
sured with a 100-mm visual analogue scale [24]. Time
spent in patient education was recorded with a stopwatch
from the beginning to the end of the patient education
session. Time to complete questionnaire and greeting
conversation was not recorded to reduce possible con-
founding factors.
Questionnaires were provided to participants to assess
outcomes before patient education, after patient education,
and after their surgery. To ensure that the presence of the
educator did not affect participants’ opinions, they were
told that their opinion would be anonymous and would not
be revealed to their educator. They also completed the
STAI questionnaire privately in a separate room from their
educator. Completed questionnaires were submitted for
data analysis anonymously.
Sample size
A pilot study was conducted with 30 patients. The decrease
in STAI after patient education was 6.53 ±6.63 and
4.40 ±8.93 for a study group and a control group,
respectively. With a 95% CI and power of 80%, the cal-
culated sample size was 215 participants in each study arm.
None of the pilot study results were included in the final
study sample.
Randomization
The investigators enrolled participants. They generated
simple randomization by tossing a coin and allocating the
participant in a 1:1 ratio to either the study group or the
control group. The investigator, who enrolled participants
and obtained informed consent, was also the person who
provided patient education.
Blinding
Participants were blinded to the nature of the intervention
(needs-based or traditional patient education). During the
informed consent process, all participants were informed
about the purpose of the study and the need to complete
questionnaires to assess anxiety and satisfaction. Partici-
pants did not know which group they were in and did not
know that there was an additional questionnaire for the
needs-based patient education group. However, the physi-
cians who provided patient education were not blinded.
Statistical analysis
Data were analyzed on an intention-to-treat basis. STATA/
SE version 12.1 was used for the analyses. Data were
reported as mean and standard deviation for all continuous
variables and as number (percentage) for discrete variables.
For nonparametric data, differences between groups were
analyzed by Mann–Whitney Utests. Pearson’s v
2
and
Fisher’s exact tests were used to compare discrete vari-
ables. A test for trend across ordered groups was used to
analyze the evolution of scores before education, after
education, and after surgery. A pvalue \0.05 was con-
sidered statistically significant.
Results
Participants and recruitment
The study flow diagram is shown in Fig. 2. Patients were
recruited over a 6-month period, from April to September,
World J Surg
123
2016. There were 225 participants in each group included
in the intention-to-treat analysis.
Baseline data
There were no significant differences in demographic data
and clinical characteristics between the two groups
(Table 1). In addition, there were no significant differences
in the operations participants received. The two groups
shared indifference in their baseline anxiety [STAI forms
Y-1 and Y-2 (trait anxiety), and VAS] and satisfaction, as
shown in Table 2.
Outcomes
The comparisons of questionnaire results before education,
after education, and after surgery showed a significant
decrease in patient anxiety and increase in satisfaction in
both groups. Across the three time points, the needs-based
group had decreased anxiety (STAI Y-1: 46.10 ±8.50,
39.01 ±10.26, 34.54 ±9.99, p\0.001; VAS:
67.4 ±20.5, 28.5 ±27.2, 17.6 ±23.9, p\0.001) and
increased satisfaction (70.8 ±20.7, 91.9 ±12.2,
94.0 ±11.2, p\0.001). The traditional group also
showed decreased anxiety (STAI Y-1: 46.96 ±8.91,
41.64 ±9.78, 37.02 ±10.34, p\0.001; VAS:
66.0 ±25.7, 41.0 ±27.1, 29.4 ±22.2, p\0.001) and
increased satisfaction (70.5 ±21.2, 86.5 ±15.8,
90.0 ±9.1, p\0.001) over the three time points.
Excluded (n=20)
Did not meet inclusion criteria (n=18)
Declined to participate (n=2)
Analyzed (n=225)
Excluded from analysis (n=0)
Analyzed (n=225)
Excluded from analysis (n=0)
Intention-to-treat
Analysis
Randomized (n=450)
Enrollment Assessed for eligibility (n=470)
Received operation and completed questionnaire
after operation (n=224)
Did not receive operation (n=1)
Received operation and completed questionnaire
after operation (n=224)
Did not receive operation (n=1)
Allocated to needs-based patient education (n=225)
Completed questionnaires before and after
education (n=225)
Did not receive allocated intervention (n=0)
Allocated to traditional patient education (n=225)
Completed questionnaires before and after
education (n=225)
Did not receive allocated intervention (n=0)
Allocation
Operation
Fig. 2 Study flow diagram
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Table 2shows a summary of the results. The compar-
ison of needs-based education with traditional education
showed a greater decrease in anxiety (STAI Y-1:
7.09 ±7.02 vs. 5.33 ±7.70, p=0.001; VAS:
38.9 ±19.3 vs. 25.0 ±24.2, p\0.001) and greater
increase in satisfaction (21.1 ±16.0 vs. 16.0 ±21.6,
p\0.001) in the needs-based group compared with the
traditional group.
The education time in the needs-based group was also
significantly less than in the traditional group
(171.8 ±87.59 vs. 236.32 ±101.27 s, p\0.001). The
preferred amount of information for each topic in the
needs-based education is shown in Table 3. More partici-
pants preferred concise information than detailed infor-
mation, especially with regard to procedural details
(73.8%). Few participants (\8%) preferred not to receive
any information.
Table 1 Demographic data: Data are presented as number (percentage) or mean ±SD
Demographic data Needs-based education Traditional education pvalue
1. Age (years) 32.36 ±15.19 31.86 ±15.48 0.985
2. Sex 0.448
Male 95 (42.2) 103 (45.8)
Female 130 (57.8) 122 (54.2)
3. BMI 23.21 ±4.49 23.35 ±4.25 0.405
4. Education 0.876
Primary 16 (7.1) 15 (6.7)
Secondary 61 (27.1) 59 (26.2)
Undergraduate 135 (60.0) 145 (64.4)
Graduate 13 (5.8) 6 (2.7)
5. Trait anxiety (STAI Y-2) 45.01 ±8.32 45.58 ±7.69 0.420
BMI body mass index, SD standard deviation, STAI State-Trait Anxiety Inventory
Table 2 Summary of results: Data are shown as mean ±SD
Results Needs-based education Traditional education pvalue
Before education
State anxiety (STAI Y-1) 46.10 ±8.50 46.96 ±8.91 0.369
Anxiety (VAS) 67.4 ±20.5 66.0 ±25.7 0.912
Satisfaction 70.8 ±20.7 70.5 ±21.2 0.355
After education
State anxiety (STAI Y-1) 39.01 ±10.26 41.64 ±9.78 0.030
Anxiety (VAS) 28.5 ±27.2 41.0 ±27.1 \0.001
Satisfaction 91.9 ±12.2 86.5 ±15.8 \0.001
After operation
State anxiety (STAI Y-1) 34.54 ±9.99 37.02 ±10.34 0.037
Anxiety (VAS) 17.6 ±23.9 29.4 ±22.2 \0.001
Satisfaction 94.0 ±11.2 90.0 ±9.1 \0.001
Differences between before and after education
State anxiety (STAI Y-1) 7.09 ±7.02 5.33 ±7.70 0.001
Anxiety (VAS) 38.9 ±19.3 25.0 ±24.2 \0.001
Satisfaction 21.1 ±16.0 16.0 ±21.6 \0.001
Education time (s) 171.8 ±87.59 236.32 ±101.27 \0.001
SD standard deviation, STAI State-Trait Anxiety Inventory, VAS visual analogue scale
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Discussion
Interpretation
Needs-based patient education decreased preoperative
anxiety and increased satisfaction more than traditional
patient education. Needs-based education also required less
time, as almost half of the participants preferred concise
information. This result highlights the benefit of patient
assessment before providing information. Similar to the
way in which patients have to be assessed before receiving
treatment, patients’ need for information should also be
assessed before information is provided. This results in
better outcomes and also saves time.
The better outcomes are consistent with the previous
study on rheumatoid arthritis [14]. Needs-based education
uses the principle of shared decision-making [15] and adult
learning theory to provide different content based on an
individual’s background and needs [16]. Our study con-
firmed that needs-based education benefits surgical patients
in addition to patients with rheumatoid arthritis, as shown
previously.
There are many novel interventions that aim to improve
preoperative patient education. However, although some of
these interventions can improve other aspects, they gen-
erally do not decrease anxiety more than traditional edu-
cation [4,25–29]. These interventions include leaflets,
video, interactive video, multimedia, and websites [25–29].
The major difference between these interventions and a
needs-based intervention is the amount of information
provided to patients. The various interventions represented
changes in the mode of information delivery, but not
changes in the amount of information provided. It is pos-
sible that the patient might not have received the amount of
information suited to their coping style. For example, a
patient with an avoidant coping style who desires a mini-
mal amount of information may get more anxious as a
result of the detailed information provided for general
patients [1,11,12]. Therefore, the appropriate amount of
information should always be considered when addressing
patient anxiety.
The result that needs-based education increased satis-
faction was not surprising. When considering other inter-
ventions, almost all interventions were found to increase
satisfaction [4,25–29]. This can be explained by the fact
that patients’ expectations determine their satisfaction [30].
Any intervention additional to traditional care may surpass
patient expectations and increase satisfaction [30]. What
needs-based patient education offers that is different from
other interventions is patient participation in choosing their
own level of information. This participatory style is helpful
and reported to increase satisfaction and reduce the number
of patients that change their physician [31,32]. However, it
was surprising that needs-based education may offer these
benefits with less time spent in education.
Needs-based patient education decreased time spent in
patient education because most patients did not require
detailed information for all relevant topics, and physicians
could cover some aspects (especially procedural details)
more concisely. It has previously been reported that some
words that occur in procedural detail (e.g., ‘knife’ and
‘scalpel’) can also trigger anxiety [33]. As shortness of
time is a major reason for omitting patient education [19],
this method can save time in clinics and encourage
physicians who have limited time to provide patient
education.
Generalizability
Needs-based patient education is simple and easy to per-
form. The central aspect is to assess patient needs before
providing information. The multicenter design used in this
study enhanced the generalizability of the results for needs-
based patient education in patients undergoing excision
which is a common procedure in day surgery. As the
intervention involved patients of both sexes, all ages
(18 years and over), and all educational backgrounds, the
outcomes suggest that a range of patients would benefit
from needs-based patient education.
Limitations
First, basic procedures were chosen to limit confounding
factors in this study, so the outcomes were limited to day
surgery performed under local anesthesia. More complex
procedures that involve general anesthesia or other types of
procedures should be investigated in a further study. Sec-
ond, cultural difference between countries should be aware
before generalization of the findings because patients in
different nations could be different. Third, outcome mea-
surement was subjective and used a standardized
Table 3 Preferred amount of information on each topic
Topics Preferred amount of information
n(%)
None Concise Detailed
1. Disease information 8 (3.6) 111 (49.3) 106 (47.1)
2. Procedural details 16 (7.1) 166 (73.8) 43 (19.1)
3. Complications – 125 (55.6) 100 (44.4)
4. Patient behavior 12 (5.3) 113 (50.2) 100 (44.4)
5. Pain 8 (3.6) 115 (51.1) 102 (45.3)
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123
questionnaire. Fourth, patients who were illiterate and
could not complete the questionnaire were not included in
the study. The benefit of needs-based education is unclear
in this population. Lastly, performing effective needs-
based patient education requires practice. Physicians
should receive training and understand the difference
between concise and detailed information to be able to
deliver information effectively.
Conclusion
Needs-based patient education can decrease preoperative
anxiety and increase satisfaction compared with traditional
patient education and takes less time.
Acknowledgements This study is dedicated to a girl patient who
came to have surgery at our clinic and cried. She taught us that
preoperative anxiety really existed and was critical. This research
represents our promise to her that we will improve ourselves to serve
patients better and will share our findings worldwide to help other
patients like her.
Compliance with ethical standards
Conflict of interest None of the authors has a financial interest in
any of the products, devices, or drugs mentioned in this manuscript.
References
1. Grieve RJ (2002) Day surgery preoperative anxiety reduction and
coping strategies. Br J Nurs 11(10):670–678
2. Brooks JE, Herbert M, Walder CP, Selby C, Jeffcoate WJ (1986)
Prolactin and stress: some endocrine correlates of pre-operative
anxiety. Clin Endocrinol 24(6):653–656
3. Fell D, Derbyshire DR, Maile CJD, Larsson IM, Ellis R, Achola
KJ et al (1985) Measurement of plasma catecholamine concen-
trations: an assessment of anxiety. Br J Anaesth 57(8):770–774
4. Alanazi AA (2014) Reducing anxiety in preoperative patients: a
systematic review. Br J Nurs 23(7):387–393
5. Hobson JA, Slade P, Wrench IJ, Power L (2006) Preoperative
anxiety and postoperative satisfaction in women undergoing
elective caesarean section. Int J Obstet Anesth 15(1):18–23
6. Ranjbar F, Akbarzadeh F (2010) P01-299—effect of preoperative
information and reassurance in decreasing anxiety in patients who
are candidate for coronary artery bypass graft surgery. Eur Psy-
chiatry 25:512
7. Rhodes L, Nash C, Moisan A, Scott DC, Barkoh K, Warner WC
Jr et al (2015) Does preoperative orientation and education
alleviate anxiety in posterior spinal fusion patients? A prospec-
tive, randomized study. J Pediatr Orthop 35(3):276–279
8. Gillies MA, Baldwin FJ (2001) Do patient information booklets
increase perioperative anxiety? Eur J Anaesthesiol 18(9):620–622
9. Andrew JM (1970) Recovery from surgery, with and without
preparatory instruction, for three coping styles. J Pers Soc Psy-
chol 15(3):223–226
10. Bellani ML (2008) Psychological aspects in day-case surgery. Int
J Surg 6(Suppl 1):S44–S46
11. Mitchell M (2000) Psychological preparation for patients
undergoing day surgery. Ambul Surg 8(1):19–29
12. Mitchell M (2001) Constructing information booklets for day-
case patients. Ambul Surg 9(1):37–45
13. Ndosi M, Adebajo A (2015) Patient education in rheumatoid
arthritis: is the needs-based approach the way forward? Clin
Rheumatol 34(11):1827–1829
14. Ndosi M, Johnson D, Young T, Hardware B, Hill J, Hale C et al
(2015) Effects of needs-based patient education on self-efficacy
and health outcomes in people with rheumatoid arthritis: a mul-
ticentre, single blind, randomised controlled trial. Ann Rheum
Dis 75(6):1126–1132
15. Barry MJ, Edgman-Levitan S (2012) Shared decision making-
pinnacle of patient-centered care. N Engl J Med 366(9):780–781
16. Bryan RL, Kreuter MW, Brownson RC (2009) Integrating adult
learning principles into training for public health practice. Health
Promot Pract 10(4):557–563
17. Newell R, Ziegler L, Stafford N, Lewin RJ (2004) The infor-
mation needs of head and neck cancer patients prior to surgery.
Ann R Coll Surg Engl 86(6):407–410
18. Harcourt D, Rumsey N (2004) Mastectomy patients’ decision-
making for or against immediate breast reconstruction. Psy-
chooncology 13(2):106–115
19. Aghakhani N, Nia HS, Ranjbar H, Rahbar N, Beheshti Z (2012)
Nurses’ attitude to patient education barriers in educational
hospitals of Urmia University of Medical Sciences. Iran J Nurs
Midwifery Res 17(1):12–15
20. Schulz KF, Altman DG, Moher D (2011) CONSORT 2010
statement: updated guidelines for reporting parallel group ran-
domised trials. Int J Surg 9(8):672–677
21. King J, Chamberland P, Rawji A, Ager A, Leger R, Michaels R
et al (2014) Patient educational needs of patients undergoing
surgery for lung cancer. J Cancer Educ 29(4):802–807
22. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA
(1983) Manual for the state-trait anxiety inventory. Consulting
Psychologists Press, Palo Alto
23. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D
(2000) The visual analog scale allows effective measurement of
preoperative anxiety and detection of patients’ anesthetic con-
cerns. Anesth Analg 90(3):706–712
24. Brokelman RB, Haverkamp D, van Loon C, Hol A, van Kampen
A, Veth R (2012) The validation of the visual analogue scale for
patient satisfaction after total hip arthroplasty. Eur Orthop
Traumatol 3(2):101–105
25. Huber J, Ihrig A, Yass M, Bruckner T, Peters T, Huber CG et al
(2013) Multimedia support for improving preoperative patient
education: a randomized controlled trial using the example of
radical prostatectomy. Ann Surg Oncol 20(1):15–23
26. Kakinuma A, Nagatani H, Otake H, Mizuno J, Nakata Y (2011)
The effects of short interactive animation video information on
preanesthetic anxiety, knowledge, and interview time: a ran-
domized controlled trial. Anesth Analg 112(6):1314–1318
27. Oldman M, Moore D, Collins S (2004) Drug patient information
leaflets in anaesthesia: effect on anxiety and patient satisfaction.
Br J Anaesth 92(6):854–858
28. Cornoiu A, Beischer AD, Donnan L, Graves S, de Steiger R
(2011) Multimedia patient education to assist the informed con-
sent process for knee arthroscopy. ANZ J Surg 81(3):176–180
29. Hering K, Harvan J, Dangelo M, Jasinski D (2005) The use of a
computer website prior to scheduled surgery (a pilot study):
impact on patient information, acquisition, anxiety level, and
overall satisfaction with anesthesia care. Aana J 73(1):29–33
30. Chow A, Mayer EK, Darzi AW, Athanasiou T (2009) Patient-
reported outcome measures: the importance of patient satisfaction
in surgery. Surgery 146(3):435–443
World J Surg
123
31. Kaplan SH, Greenfield S, Gandek B, Rogers WH, Ware JE Jr
(1996) Characteristics of physicians with participatory decision-
making styles. Ann Intern Med 124(5):497–504
32. Naidu A (2009) Factors affecting patient satisfaction and
healthcare quality. Int J Health Care Qual Assur 22(4):366–381
33. Caddick J, Jawad S, Southern S, Majumder S (2012) The power
of words: sources of anxiety in patients undergoing local anaes-
thetic plastic surgery. Ann R Coll Surg Engl 94(2):94–98
World J Surg
123
