Pre-Operative DIEP Flap Patient Education Class Helps Decrease Anxiety and Increase Excitement/ Preparedness Around Surgery
lisa gfrerer, MD PhD, Matthew J. Carty, MD, Jessica Erdmann Sager, MD, Stephanie A. Caterson, MD.
Brigham and Women's Hospital, boston, MA, USA.
BACKGROUND: Patients undergoing mastectomy and DIEP flap breast reconstruction may experience psychosocial distress in the perioperative period. We hypothesized that preoperative patient and family education improves levels of anxiety, and increases excitement for surgery as well as level of preparedness. METHODS: An educational class for patients and families preparing for DIEP flap surgery was initiated. The class was held on the in-patient floor where subjects would be recovering. The session was led by a plastic surgeon, a floor nurse, and a mid level practitioner who was on the inpatient care team. Participants toured the inpatient unit, and were oriented to rooms. A group presentation was held discussing details around each day in the hospital, flap monitoring, pain management, perioperative goals, and discharge instructions. Patients were asked to complete a survey pre- and post class, as well as upon discharge. RESULTS: All patients who attended educational sessions reported positive significant change in preoperative levels of anxiety, excitement, and preparedness (see Table 1). The majority of subjects (94%) thought that the course was very helpful. Postoperatively, subjects described significantly less anxiety during their inpatient stay than pre- and post- class and felt more prepared for what they experienced in the hospital (see Figure 1). CONCLUSIONS: Pre-surgery patient education including detailed information about perioperative care, as well as exposure to inpatient facilities and pertinent providers significantly decreases levels of anxiety and increases excitement and preparedness for DIEP surgery. These findings highlight the importance of patient instruction prior to autologous breast reconstruction and stress the need for structured information sessions for prospective DIEP candidates.
| n=33 | Pre- class (mean on a scale of 0-10) | Post- class (mean on a scale of 0-10) | p value |
| Anxiety | 6.8 ± 2.2 | 4.6 ± 2.1 | <0.01 |
| Excitement | 4.9 ± 2.9 | 6.6 ± 3.0 | <0.01 |
| Preparedness | 6.1 ± 2.2 | 9.0 ± 1.3 | <0.01 |
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