Study finds inadequate patient education for scheduled urologic procedures

Investigators at the Albert Einstein College of Medicine, Bronx, New York reported that patients had an incomplete understanding of the risks, benefits, and alternatives (R/B/As) to urologic procedures that they were scheduled to receive.¹

The authors, led by Alison E. Schulz, BS, concluded that there is a need for improvement in patient education efforts and that many patients benefit from pre-procedural interviews.

A total of 99 patients were included in the study, 46% of whom women, 32% of whom were Spanish-speaking individuals, and 60.6% of whom had an education level of high school or less. The average age of patients was 64 years (SD = 10.9). Participants spanned 7 different types of urologic procedures. Most patients (93.9%) had undergone a procedure or operation before, and 35.3% had undergone the same procedure in the past.

For the study, investigators conducted phone interviews with patients and asked them to recall general knowledge about their scheduled procedure and the R/B/As associated with it. The authors compared patients’ answers to a standardized list of R/B/As and graded patient understanding on a scale of incomplete (< 25%), partial (25%-75%), and complete (> 75%).

If a patient’s understanding was found to be inadequate, additional education was given and they were queried regarding their satisfaction, which the authors called a “teachback interview.” After the teachback interview, 90% of patients were satisfied with their understanding, with some even saying that they learned most of the information from the interview. All interviews were conducted within 1 week of the patient’s scheduled procedure.

Investigators found that no patients had a complete understanding of the R/B/As of their scheduled procedure, and 73.7% had partial understanding. Approximately 55% of patients had a general knowledge of their procedure and 78% were able to recall the name of the procedure, its indication, and give a general description.

The average percent of risks identified by patients was 12%; benefits, 63%; and alternatives, 35% for all 7 procedures that were reflected in the study. Approximately 65% of participants were able to identify at least 1 risk, 92% at least 1 benefit, and 90% at least 1 alternative. Patients undergoing transurethral resection of the prostate had the lowest rate of risks identified (5.6%), and patients undergoing intravesical onabotulinumtoxinA had the highest (22.2%).

Patients were more likely to have a higher level of understanding if they were female (P = .02), underwent the same procedure previously (P < .01) or any surgery within a year (P = .02), and were undergoing an in-office procedure (P = .03).

No patients in the study had a complete understanding of the R/B/As of their scheduled procedure and over 30% had an incomplete understanding. One solution, as the investigators reported, is to conduct teachback interviews prior to scheduled procedures, but there remains a burden with time and the need to tailor the amount of information given to the desires of each individual patient.

Reference

1. Schulz AE, Dave P, Clearwater W, et al. Assessment of patient understanding prior to urologic procedures. Urology. Published online October 1, 2022. doi.org/10.1016/j.urology.2022.09.010