Review
Preparatory education for cancer patients undergoing surgery: A systematic review of volume and quality of research output over time

https://doi.org/10.1016/j.pec.2015.05.008Get rights and content

Highlights

  • Reviews the volume and scope of research on preparing cancer patients for surgery.

  • The number of studies has increased over time.

  • Benefits for anxiety, satisfaction and knowledge are mixed.

  • Further research is needed to examine multimodal interventions and carer involvement.

Abstract

Objective

To determine the volume and scope of research output examining preparation of patients for people undergoing cancer-related surgical treatment, and the impact of pre-operative education on patient outcomes and health care utilisation.

Methods

Medline, EMBASE, PsychINFO databases were systematically searched. Eligible papers were coded as data-based or non-data-based. Data-based papers were further classified as descriptive, measurement or intervention studies. Methodological quality and effectiveness of intervention studies were assessed using Cochrane Effective Practice and Organisation of Care (EPOC) criteria.

Results

We identified 121 eligible papers. The number of publications significantly increased over time. Most were data-based (n = 99) and descriptive (n = 83). Fourteen intervention studies met EPOC design criteria. Face-to-face interventions reported benefits for anxiety (5/7), satisfaction (1/1), knowledge (3/3) and health care costs (1/1). Audio-visual and multi-media interventions improved satisfaction (1/1) and knowledge (2/3), but not anxiety (0/3). Written interventions were mixed.

Conclusion

Descriptive studies dominate the literature examining preoperative education in oncology populations, with few rigorous intervention studies. Pre-operative education can improve satisfaction, knowledge and reduce anxiety.

Practice implications

Further work should be directed at multi-modal interventions, and those that include the caregiver, given their role in assisting patients to prepare and recover from surgery.

Introduction

Surgery can have a negative impact on a range of physical and psychological health outcomes. Patients report anxiety and fear about what will happen during the period of hospitalisation, and of the potential complications and outcomes of surgery [1], [2]. In extreme cases, high levels of anxiety may result in the postponement of procedures or the seeking of non-surgical alternatives [3]. Adverse consequences of heightened pre-operative anxiety include missed appointments, poor physical preparation and a stress response that can impede recovery [2]. Adverse consequences for the health care system include increased length of hospital stay, increased analgesic requirements and prolonged recovery time [4]. In contrast, pre-operative psychological resilience may protect against severe acute as well as chronic post-operative pain [5]. Unmet needs at discharge from hospital, including poor wound care, pain management and monitoring of complications, contribute to sub-optimal recovery and hospital readmissions [6].

The potential benefits of providing patients with pre-operative education on physical and psychological outcomes has been explored in multiple medical conditions [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. However, the evidence for the effectiveness of pre-operative education is mixed. Meta-analysis of seminal studies in this field found beneficial effects of psychoeducational interventions on recovery, postoperative pain and psychological distress among adult surgical patients [17]. Other meta-analyses have reported that preparatory interventions for surgical patients which provide both sensory and procedural information [18], and address fears related to the procedure [19] reduce anxiety and pain. However, a more recent review concluded that preparatory interventions for major surgery only have a positive impact on patient knowledge, and not on anxiety, pain or length of stay [14]. These mixed results reflect the heterogeneity of study populations and interventions, and suggest a need to consider the effectiveness of pre-operative education for specific patient groups [14].

Of oncology patients receiving surgery, data suggests that between 60% and 90% experience anxiety during the perioperative period [20], [21], [22]. To date there have been no reviews focusing solely on preparing cancer patients undergoing surgery. This is an important gap given the increasing incidence of cancer worldwide [23]. Evidence developed with other populations may not be generalisable to surgical cancer patients. Cancer patients face unique challenges due to a range of factors including the life threatening nature of the disease [24], the potential impact of surgery on body image [25], and the additional impact of non-surgical treatments such as chemotherapy or radiotherapy on wellbeing [26]. Additionally, surgery to treat cancer is often performed soon after diagnosis [27] when the patient may be in a state of emotional distress [28], resulting in information overload [11].

Monitoring the volume and scope of research output can help identify gaps in knowledge and inform strategies to improve the quality and relevance of research to policy and practice [29], [30], [31]. Descriptive research is needed to quantify the burden of outcomes, which can inform the development of methodologically rigorous interventions. Intervention studies provide evidence about the most effective strategies for preparing cancer patients for surgery. However, these studies must meet minimum standards of scientific quality to ensure credibility of findings.

This review aims to address an identified gap in the literature by examining the: (1) number of publications describing preparing cancer patients for a surgical procedure; (2) number of data-based publications examining preparation by research design (descriptive, measurement, intervention); and (3) methodological quality and effectiveness of pre-operative interventions aimed at improving patient outcomes and health care utilisation.

Section snippets

Search terms

Medline, EMBASE, PsycINFO and Cochrane databases were searched from the date of inception of each database (Medline 1946, Embase 1980, PsycINFO 1967, Cochrane 1992) to November 2014. Three search themes (neoplasm, patient education, surgery/surgical procedures) were combined using the Boolean operator AND. The complete list of MESH headings and search terms are listed in Appendix A: search terms. The reference lists of reviews of relevant literature and of retrieved articles were also manually

Search results

A flow diagram of the search strategy is provided in Fig. 1 a total of 599 publications were identified using the search strategy and were assessed against the eligibility criteria. Overall, 121 publications met eligibility criteria and were included in the review.

Number of studies published over time by research design

A total of 99 data-based and 22 non-data-based publications met eligibility criteria. Non-data-based papers included summary or discussion papers (n = 6); or reviews (n = 16). The most common type of data-based publications were

Discussion

This review examined the volume and scope of research output in relation to the preparation of patients for people undergoing cancer-related surgical treatment, and the impact of pre-operative education on patient outcomes and health care utilisation. Despite surgery being a common treatment for cancer, most of the 121 data-based studies have examined the preoperative education in oncology populations are cross-sectional, descriptive studies. Only 14 intervention studies were identified. Each

Conflicts of interest

None.

Authors contribution

Conception: AW, KF, RSF.

Data acquisition and/or analysis: AW, KF, JB.

Data interpretation: all authors.

Drafting and revising manuscript: all authors.

Final approval: all authors.

Acknowledgements

This research was supported by a Strategic Research Partnership Grant from the Cancer Council NSW to the Newcastle Cancer Control Collaborative (CSR 11-02), and infrastructure funding from the Hunter Medical Research Institute (HMRI). Kristy Forshaw is supported by a University of Newcastle Postgraduate Research Scholarship. Dr Jamie Bryant is supported by an ARC Post-Doctoral Industry Fellowship. Dr Mariko Carey is supported by a National Health and Medical Research Council Translating

References (50)

  • G. O'Connor et al.

    Randomised controlled trial of a tailored information pack for patients undergoing surgery and treatment for rectal cancer

    Eur J Oncol Nurs

    (2014)
  • M.J. Pritchard

    Identifying and assessing anxiety in pre-operative patients

    Nurs Stand

    (2009)
  • R.J. Grieve

    Day surgery preoperative anxiety reduction and coping strategies

    Br J Nurs

    (2002)
  • W. Caumo et al.

    Risk factors for postoperative anxiety in adults

    Anaesthesia

    (2001)
  • J. Bruce et al.

    Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study

    Pain

    (2013)
  • B. Pieper et al.

    Discharge information needs of patients after surgery

    J Wound Ostomy Continence Nurs

    (2006)
  • P. Kinnersley et al.

    Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures

    Cochrane Database Syst Rev

    (2013)
  • J.A. Palmer

    Decreasing anxiety through patient education

    Plast Surg Nurs

    (2007)
  • A.K. Danielsen et al.

    Patient education has a positive effect in patients with a stoma: a systematic review

    Colorectal Dis

    (2013)
  • A. Lee et al.

    Educating patients about anesthesia: a systematic review of randomized controlled trials of media-based interventions

    Anesth Analg

    (2003)
  • J.A. Walker

    What is the effect of preoperative information on patient satisfaction?

    Br J Nurs

    (2007)
  • T.O. Oshodi

    The impact of preoperative education on postoperative pain. Part 2

    Br J Nurs

    (2007)
  • S. McDonald et al.

    Pre-operative education for hip or knee replacement

    Cochrane Database Syst Rev

    (2004)
  • M. Ronco et al.

    Patient education outcomes in surgery: a systematic review from 2004 to 2010

    Int J Evid Based Healthc

    (2012)
  • J. Suls et al.

    Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis

    J Consult Clin Psychol

    (1989)
  • Cited by (65)

    • Enhanced recovery after surgery (ERAS) nursing programme

      2022, Asia-Pacific Journal of Oncology Nursing
    View all citing articles on Scopus
    View full text