Preoperative patient education involves a team effort to make patients knowledgeable and active participants in their care through multiple teaching modalities. The goals are to improve understanding of the disease/operation and ensure active participation, while also obtaining informed consent. Key topics covered include the planned procedure, risks/alternatives, postoperative expectations like pain management, and procedure-specific details. Teaching tools can include verbal instructions, written materials, web-based resources, and visual aids.
4. Initial visit
•Recommendation for surgery
•Sufficient time is allocated
•Questions are encouraged
Subsequent visit
•Review the planned procedure
•Additional questions are answered
•Preop anesthesia clinic visit
5. Content of preoperative teaching
Related to surgery (or thoracic surgery) in general
Issues related to a specific operation
6. Content of preoperative teaching
General preoperative education
Respiratory hygiene
Pain
Smoking cessation
Diet and nutrition
Wound care and drains
Postdischarge social issues
Contact numbers
8. General preoperative evaluation
Understanding of the planned
procedure
Why it is being recommended
What its risks are
Whether there are alternatives
Role of active patient
participation
15. Respiratory hygiene
• Setting expectations is important
• Far more effective preoperatively than
postoperatively when breathing is compromised by
pain
• Baseline spirometry readings
• Easy to convince target values in postop
period
18. Pain
Discussion of narcotic analgesics,
patient- controlled analgesia,
nonsteroidal analgesics, and
epidural anesthesia (continuous,
intermittent, and patient controlled)
Side effects, including
nausea, gastrointestinal
dysfunction, and the
potential for a lack of
efficacy
Goal of postoperative analgesia
pain control that provides patients
with an ability to function and
interact with their environment
effectively
Goal
OptionsSide effects
20. Smoking cessation
Thoracic surgery mostly deals with smoking related pathology
May/may not quit smoking
• addictive qualities of nicotine outweigh the intellectual knowledge that
smoking is harmful
May use smoking as a method of coping with anxiety and fear
Cigarette smoking impairs the mucociliary clearance mechanisms of the
tracheobronchial tree and may predispose to postoperative pulmonary
complications.
21. Smoking cessation
The optimal time for smoking cessation is unclear
Most surgeons encourage patients to stop smoking in preparation for thoracic
surgery.
Whether surgery should be denied to patients who continue to smoke is
controversial.
Every effort should be made preoperatively to persuade the patient to stop
smoking.
22. Diet and Nutrition
Significant recent weight loss
Preoperative chemotherapy or radiation therapy
Nutritional deficiencies can be expected and consequently preempted.
Patient questions regarding nutritional supplementation to be addressed
23. Wound care & Drains
Patients often have negative expectations about
wound care and often are pleasantly surprised to learn
that care is usually minimal.
Patients should be taught about the uses and benefits
of percutaneous tubes and drains.
24. Post-discharge social issues
Family involvement in postoperative convalescence
Job-related concerns
Expectations regarding physical limitations, including appetite, sleep irregularity etc
Cultural sensitivity and family dynamics may play crucial roles in
effecting a smooth post- operative recovery.
27. Procedure-specific teaching
ď‚´ Pulmonary resection (lobectomy/pneumonectomy)
ď‚´ Thoracoscopy
ď‚´ Lung volume reduction surgery
ď‚´ Esophagectomy
ď‚´ Photodynamic therapy
ď‚´ Transplantation
Often can be discharged the day after surgery
Presence of a chest tube often dictates an
overnight stay
28. Procedure-specific teaching
ď‚´ Pulmonary resection (lobectomy/pneumonectomy)
ď‚´ Thoracoscopy
ď‚´ Lung volume reduction surgery
ď‚´ Esophagectomy
ď‚´ Photodynamic therapy
ď‚´ Transplantation
Risk of prolonged air leaks.
Risks of pneumonia
Potential for postoperative mechanical
ventilation
Use of one-way valves and the possibility of
being discharged home with a chest tube in
place can be discussed
30. Procedure-specific teaching
ď‚´ Pulmonary resection (lobectomy/pneumonectomy)
ď‚´ Thoracoscopy
ď‚´ Lung volume reduction surgery
ď‚´ Esophagectomy
ď‚´ Photodynamic therapy
ď‚´ Transplantation
Lifelong involvement with the transplant center
Ongoing use of multiple medications
Need for periodic physiologic and pathologic
assessment
Preoperative assessment frequently involves
psychologists (or psychiatrists) and social
workers
33. Written materials / leaflets
Verbal
instruction
Written
material
Web-based
material
Audiovisual
material
Commercial product-
specific patient education
packets
“In-house” procedure-
specific information
booklets
Patient education
materials, leaflets
36. Summary
ď‚´The goal of patient teaching is to
improve patients’ understanding of their disease process
and the operation
ď‚´ensure their active participation in the treating process
ď‚´The additional goal of obtaining informed consent is
an ingrained component to the current physician-
patient relationship.