Evaluation of generic patient information: Effects on health outcomes, knowledge and satisfaction
Introduction
The provision of quality patient information is now generally recognised as an essential tenet of good health care. Patients themselves demand information with Lithner and Zilling concluding their study of 50 patients admitted for cholecystectomy that patients “want a lot of information both at admission and discharge” (page 29), moreover they claimed 30% wanted both written and verbal information [1]. Written information is increasingly expected and Bellew et al. found that once parents had received a written information leaflet about their child's anaesthetic the majority felt verbal information alone would not have been enough [2].
Since Coulter, Entwistle and Gilbert's seminal report “Informing Patients” in 1998 substantial progress has been made in raising the quality of patient information [3]. The use of design guidelines, evaluation with instruments such as the “DISCERN” designed to evaluate the reliability, and quality of information on treatment choices in written health information [4] and the “SAM” [5] which assesses the suitability of written information under six headings which include content and cultural appropriateness; and the stimulus provided by the establishment of NHS Direct, the BMA Patient Information Awards and PALS (patient advice and liaison service) in each trust, are some of the key factors. However, despite the recognition of patients’ desire for written information and real attempts to improve its quality there exists little uniformity in both the amount and quality of information provided as can be seen by the plethora of reviews of written information [6], [7]. One way forward may be for hospitals to make use of commercially published information.
To date less effort, has been devoted to establishing that good quality patient information fulfils the requirements of patients and professionals involved in their healthcare. These requirements include increasing patient knowledge, satisfaction and post-operative well being while decreasing anxiety. Studies have tended to focus on patient satisfaction and have been hampered by patients’ tendency to report high satisfaction regardless of individual experience, as they appear unwilling to report negative views [2], [8], [9], [10]. The effect of patient information on anxiety has produced conflicting results with one recent study finding no statistically significant difference in state anxiety as measured by the Speilberger State-Trait Anxiety Inventory, between the control and intervention group [10]. While, another study found 35% of patients who read a booklet about anaesthesia claimed to have been worried by it [11]. Such studies are always confounded by whether the information is actually read and understood as this tends to be evaluated in a very informal manner for example in the above study patients were merely asked “did you understand it” [11]. More objective measures are needed to evaluate both patient's understanding and any possible post-operative benefit to them.
This study was therefore an attempt to answer the following research questions:
- (1)
Does the provision of additional commercially produced written information increase patient knowledge and satisfaction?
- (2)
How does patient information affect health-related quality of life?
- (3)
Is there a place for commercially published standardised patient information?
Section snippets
Method
A randomised controlled trial design was used to compare two groups of elective surgical patients, with allocation by randomised block (block = 1 week) to reduce possible cross-contamination. Patients due to be admitted for elective surgery, were sent a letter inviting them to participate in the study prior to the routine pre-admission appointment all patients attend. Attached to the letter was an information sheet about the study and for the experimental group the first of the three commercially
Results
The experimental and control groups did not differ in gender, age, educational level, surgical procedure, length of stay or post-discharge complications (all ps > 0.05). Four patients had limiting medical conditions and so were excluded from the analyses. Ages ranged from 19 to 80 with a mean of 53 years. The majority of patients had not continued in full-time education after 16, the median age for leaving full-time education was 15. A third of the participants had their operation cancelled at
Discussion and conclusions
The provision of extended patient information did have some impact on health outcomes. Patients in the experimental group were less anxious immediately before their operation, Bellew et al.'s study also found that the provision of an information leaflet to parents about their child's anaesthetic reduced their anxiety, although a non-significant trend, over half the parents in the leaflet group reported feeling ‘less anxious’ [2]. The finding that the experimental group reported greater feelings
Acknowledgement
This research was funded by Scriptographic Publications Ltd., Alton, Hampshire, UK. The other contributors are Christopher Coldham, Research Nurse, Nursing and Therapy Research Unit, Queen Elizabeth Hospital, Birmingham – participant recruitment and data collection; Frances Grant, Research Director, Nursing and Therapy Research Unit, Queen Elizabeth Hospital, Birmingham – study liaison and organisation.
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