Patients' perceptions of brain health after surgery: a mixed-methods study of perioperative risk communication in older surgical patients in New Zealand.

Résumé

BACKGROUND: We explored how adult surgical patients perceived their risk of major postoperative complications, including neurological complications, and how much information they wanted to receive about such risks.METHODS: We undertook a mixed-methods study including a 13-item survey and thematic analysis of semi-structured interviews with patients undergoing noncardiac, non-neurologic surgery.RESULTS: Of 557 distributed surveys, 547 were returned completed. Of these, 88% of respondents had previously undergone surgery. Respondents were most likely to indicate an extreme level of concern for major stroke (64%), followed by heart attack (56%), minor stroke (46%), and cognitive decline (43%). Women were more likely to indicate a higher level of concern for cognitive decline than men (odds ratio 1.6, 95% confidence interval 1.1-2.4, P=0.015). Seventeen people participated in interviews. Six themes were identified: (1) trust in healthcare professionals; (2) surgery to achieve hopes and ambitions; (3) previous experiences govern expectations and perception of risk; (4) positive outlook and spirituality as protective factors; (5) support matters; and (6) a personalised approach to risk discussion.CONCLUSIONS: Many participants did not know the risks of major perioperative complications but based their risk perception on previous experiences and trust in health professionals. Participants focused on hope more than their concerns. Information provision should be personalised as patients expressed differences in the desired amount of information on risks.