Introduction: Numerous studies have shown patients lack adequate understanding of procedures they are undergoing and its potential risks, benefits and alternatives (R/B/A). The teachback method is the most effective way to evaluate and reinforce patient understanding. Using this technique, we evaluated whether patients undergoing elective urological surgeries at our institution had adequate understanding.
Methods: This was a prospective study where a research assistant conducted a pre-operative (pre-op) phone interview within a week prior to a patient’s scheduled procedure. Using standardized questions, patients were asked to recall general knowledge and R/B/A of the procedure. A scoring system compared patient responses to a standardized list of R/B/A to analyze the level of understanding (LoU), graded as incomplete ( <25%), partial (25-75%), or complete (>75%). Further education was provided if LoU was incomplete or partial. At the end of the interview, patients were queried regarding their satisfaction with their LoU.
Results: One hundred patients were interviewed with 99 included in the analysis. The patient population was 46% women, 32% Spanish speaking, and a mean age of 64 years. Seven operations were included: intravesical botulinum toxin injection (24), sling (9), colpocleisis (4), prostate biopsy (24), ureteroscopy (16), transurethral resection prostate (11), transurethral resection bladder tumor (11). The average percent of R/B/A identified across all procedures was 12%, 63%, and 35% respectively. No patients had complete LoU, but most had partial (5/7 procedures). Patients were found to have significantly higher LoU if they were female (p = 0.023), had the same surgery previously or any surgery within a year (p = 0.002, p = 0.023), and were undergoing in-office procedures (p = 0.025). After re-education, most patients (90%, n = 87) were satisfied with their LoU.
Conclusions: Patient pre-op understanding was alarmingly incomplete in our cohort. There was substantial benefit in conducting a pre-op phone interview utilizing the teachback method, with 90% of patients satisfied with their LoU upon interview completion. Our findings highlight the need for improvement in patient education prior to surgery and offers a potential solution using a telephone interview based on the teachback method.