The present study confirms the supposition that surgical patients, even in a “semi-rural” environment, are interested in all domains of the hospital admission process. In the present study striking differences in opinions were observed in the domains of postoperative period and self care, as patients judged these issues approximately 25% more important compared to their surgeons. On the other hand, our surgeons are convinced that their patients are predominantly focused on aspects belonging to domains of disease, examination, and operation.
The results of this study show that surgeons underestimated their patients’ need for extensive and adequate provision of preoperative information. Surgeons routinely fail to meet their clients’ hunger for information and apparently misperceive the process of information transfer [6
]. One study concluded that doctors underestimate their patients’ desire for information in 65% of their encounters [18
]. Surgical patients in an interviewed group of 60 patients were also found to have a selective informational desire as they appeared more interested in specifics of the operation and recovery (43.3% each) than in operative risks (33.3%) [21
]. Another study including patients receiving hip surgery demonstrated that they were eager to know almost all aspects of their operation, in contrast to what their doctors thought [22
Different patient characteristics determine this desire for preoperative information. Gender apparently plays a role, as women visit doctors more often, require more emotional support, ask more questions, and are engaged in more verbal behavior with health care providers compared to men [18
]. This higher need for information associated with female gender is anticipated by their doctors, as women usually receive more doctor time and more levels of explanations [18
]. The present study confirms this gender difference, as women surgical patients scored significantly higher than their male counterparts in all domains except issues related to the domains disease, examination, and general information (all of which were scored higher by women, but not significantly). Informational needs were not related to the patient’s age.
One would assume that complex surgery a priori requires more explanation, and patients scheduled to undergo class 3–6 operations would demand more information than patients undergoing simple class 1–2 surgery, because the topic is more complex and complications more severe. However, our results do not confirm this assumption. In contrast, patients that were scheduled to undergo a class 1–2 operation scored higher in the “self-care” domain than the class 3–6 patients. This apparent contradiction may be explained by the fact that class 1–2 patients are quickly discharged (most of the time on the day of operation) and immediately have to rely on themselves to cope with daily demands. Interpretation of these results must be performed with caution, however, as our patients were allowed to answer questions regarding the operative procedure anonymously, and only 58% of the patients (n = 72) reported their operative procedure on the questionnaire. We have no indications that patients who are scheduled for more complex operations have greater informational needs as compared to patients who are scheduled for simpler operative procedures.
Current care providers intend to use the most effective ways to adequately deliver sets of required information that patients can reproduce at any time. Unfortunately, patients appear to remember only few items of all the information that is transferred by their doctors. Their level of knowledge quickly deteriorates from the initial consultation on, despite supportive measures, including information booklets. It may even be argued that patients are insufficiently informed to properly consent to a standard “informed consent procedure” [24
]. Improving patient information using alternative strategies may have an impact on these issues and may also have legal consequences.
How can results of the present study be transferred to daily surgical practice? Time restraints as well as lack of skills in basic communication are common in a surgical practice and contribute to suboptimal transfer of information. It is clear from this and other studies that major improvements have to be made in patient education. Interactive computer programs may contribute to solving these problems. One study evaluating the efficacy of a video film on inguinal hernia repair demonstrated improved patient understanding, higher satisfaction, and reduced doctors’ time [24
]. Moreover, interactive computer programs appear capable of drastically improving knowledge retention from 20% to 80% and may thus be a great improvement for informed consent procedures [26
]. A computer program does have the time to discuss all important domains to any extent a patient chooses without ever forgetting important information [27
]. A computer program has the potential of aiding in educating patients on specific issues related to the scheduled operative procedure and it buys time for surgeons to answer specific questions.
A recent trial comparing patient education by a doctor or a computer program concluded that doctors indeed can be replaced by a computer program [28
]. Patients learned more by using the computer program and were also equally satisfied with either education they received. Modern surgical practice can be improved by using interactive computer programs in patient education.
One may question whether the design of the present study is optimal. For instance, conclusions were drawn on the basis of comparisons of VAS scores. A recent study concluded that an alternative verbal rating score (VRS) may perform better compared to a VAS system [29
]. Irrespective of the design, the present study demonstrates that improvements in patient education in general are needed and probably attainable. Future research on the efficacy of computer techniques as an alternative for patient education is warranted.