Patient satisfaction and cardiac surgery - a pilot studyFrøydis Nermoen, Astrid Lavoll-Nylenna, Øivind Ekeberg*, Knut Kvernebo Dept. of Cardiothoracic Surgery and *Dept. of Emergency Medicine, Ullevaal University Hospital
Introduction: Norwegian patients have since 2002 been able to freely choose among all public hospitals for elective surgery. Patients’ choice is probably based on assessment of quality of medical care, but also on factors like hospital reputation and facilities. Few studies so far have evaluated patient satisfaction with doctors, nurses and facilities and the psychological impact of a cardiac surgery (coronary artery bypass graft (CABG) and aortic valve replacement (AVR)).
Aim: To study patient satisfaction, quality of life, anxiety, depression and symptoms of post traumatic stress in patients who have undergone elective cardiac surgery.
Material and methods: During 11 months from October 2003, 7 women (mean age 67 (range 53-72)) and 17 men (mean age 63 (49- 73)) undergoing elective low to medium risk CABG (N=16) and/or AVR (EuroScore ≤8) were included. The patients filled in three questionnaires (one day prior to surgery, 14 days and 6 months after the operation about quality of life (SF36), anxiety and depression (HADS), symptoms of post traumatic stress (IES) and a 40 items questionnaire about patient satisfaction specially designed for this study concerning facilities, satisfaction with doctors and nurses and the overall evaluation of the hospital. Of the 24 patients included, 17 patients answered questionnaire number 3.
Results: The main finding was that the patients were very satisfied with the doctors and nurses (scores above 8,5/10), facilities (8,6/10) and overall satisfaction (9,2/10). The exception is patients’ satisfaction with the quality of information. Women generally scored lower than men on satisfaction with information given. The difference between the genders was high concerning satisfaction about the information given ahead about the procedures of the surgery (women scored an average of 7,6 and all the men scored top score of 10). Patients were especially disapproving of the information given about what to expect after being discharged from hospital (score 5,9/10). In spite of improvement in physical function, the patients reported a lower general health six months after the operation than before the operation. Three of the women, (43 %) scored above the threshold for a potential anxiety disorder. One in four of the men scored threshold values for anxiety disorder before the surgery, 3/16 (19 %) reported moderate or severe anxiety. Regarding depression women scored an average of 7,1 14 days after the surgery. The threshold for mild depression is 8, moderate 11. 3/7 reported a mild or moderate depression. The psychological strain was not evenly distributed among the patients, but generally the level of anxiety and depression normalised within six months. On both anxiety and depression, women report higher scores than men. Three patients reported symptoms of post traumatic stress, but the majority of the patients report a low level of intrusion and avoidance. The pilot study implies that patients and examinators saw a need for simplifying the questioners.
Discussion: Despite the fact that more than 500 cardiac operations are performed at Ullevål Universitetssykehus every year, inclusion of patients has been a problem. A competing study, the patients’ high age and a negative attitude towards inclusion are among the reasons. The representativity of the patients may thus be limited. A strength is the prospective design of the study.
Conclusion: The patients were generally very satisfied with their hospital experience and showed great confidence in the hospital. A cardiac operation is associated with increased anxiety and depression, but these reactions seem to be transient, and normalized within six months. The use of questionnaires gives an opportunity to evaluate and compare different departments, and to identify patients with a need for extra follow up. A larger study should be carried out.