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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Surgical patient education: assessing the interventions and exploring the outcomes from experimental and quasiexperimental studies from 1990 to 2003

K Johansson, S Salantera, K Heikkinen, A Kuusisto, H Virtanen, and H Leino-Kilpi.

Review published: 2004.

CRD summary

This review assessed educational interventions for surgical patients. The authors concluded that there was some evidence of the effectiveness of educational interventions, but more research is required. The review was limited by the lack of duplication in the review process and the lack of a quality assessment. There was insufficient evidence to support the authors' conclusion regarding effectiveness.

Authors' objectives

To assess the effects of educational interventions for surgical patients.

Searching

MEDLINE (from 1966 to 2003) and the Cochrane Library (Issue 3, 2003) were searched for studies published in English during or after 1990; the keywords were reported. The authors reported some handsearching and reference scanning but gave no further details.

Study selection

Study designs of evaluations included in the review

Studies of experimental or quasi-experimental design were eligible for inclusion if they used random sampling, had a control group, or involved manipulation of treatment.

Specific interventions included in the review

Studies of nursing interventions of patient education were eligible for inclusion. Studies of other nursing interventions were excluded. The interventions in the included studies were mainly carried out pre-operatively and focused on the pre-admission stage; fewer studies (20%) were carried out post-operatively and these focused on information, function, exercises, care and recovery. The majority of studies delivered interventions using a variety of different educational methods. Most studies did not describe the control intervention in detail but described it as 'usual', 'routine' or 'traditional care'.

Participants included in the review

Studies of adult surgical patients were eligible for inclusion. Studies of patients aged less than 18 years and patients with mental diseases were excluded. Most of the studies were of patients undergoing cardiac surgery; other types of surgery included orthopaedic, opthalmic, hernia, varicose, abdominal, breast cancer and general ambulatory surgery. The mean age of the patients was 59 years (based on 66% of studies).

Outcomes assessed in the review

Inclusion criteria for the outcomes were not specified. The included studies most commonly assessed experiential aspects (primarily anxiety and satisfaction), followed by cognition (primarily knowledge) and functionality (primarily exercise performance and regularity). The majority of the studies measured outcomes using questionnaires developed by the authors of the primary studies.

How were decisions on the relevance of primary studies made?

One author selected studies for inclusion and discussed this with the other authors.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

One author extracted the data and discussed this with the other authors.

Methods of synthesis

How were the studies combined?

The results were tabulated according to empowerment aspects (biophysiological, functional, cognitive experiential, societal and financial) of the outcomes measured. The review reported the proportion of studies reporting no statistically significant results, both positive and negative results, and positive effects only. The results for studies measuring the most commonly measured outcomes and for studies showing positive effects were considered separately.

How were differences between studies investigated?

Differences between the studies were discussed with respect to the interventions, timing and content of interventions, and methods used to measure outcomes.

Results of the review

Thirty-two studies (n=2,723) were included: 30 randomised controlled trials (RCTs; n=2,634) and 2 non-randomised trials (n=89).

About half (41%, n=13) of the studies reported no statistically significant results, half (50%, n=16) reported both positive and negative results, and only 2 studies reported positive effects only.

Studies assessing anxiety and satisfaction showed inconsistent results.

Two of the 3 studies assessing post-operative efficacy showed positive results.

Five of the 13 interventions measuring knowledge showed a positive effect.

Studies assessing the effect on prescribed exercises showed inconsistent results.

One of the positive studies showed that pre-operative provision of information in the patients' homes reduced anxiety, while the other showed that a post-operative intervention providing support to patients after discharge reduced anxiety.

Authors' conclusions

There was some evidence of the effectiveness of educational interventions, but more research is required.

CRD commentary

The review addressed a broad research question encompassing a wide range of intervention types. Only two databases were searched and this might have resulted in the omission of relevant studies. Limiting eligible studies to those published in English raises the possibility of publication bias, but it was unclear whether attempts were made to locate unpublished studies. Only one reviewer selected studies and extracted the data; the extent of the involvement of the other reviewers in this process was not clear. Validity was not assessed, and it was not reported whether the data were extracted on an intention-to-treat basis or whether the studies were sufficiently powered to detect a difference between interventions if one existed.

Given the differences among studies, a narrative synthesis was appropriate. However, the quality of the included studies was not taken into account when discussing the results. Where studies showed inconsistent results, potential reasons for this were not discussed. There was insufficient evidence to support the authors' conclusion regarding the effectiveness of educational interventions, but sufficient evidence to support the need for further research.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that there is a need for further research to develop educational interventions for surgical patients. They recommended that future research include the use of standardised outcome measures and strong study design (RCTs), and pay close attention to the planning and implementation of studies.

Bibliographic details

Johansson K, Salantera S, Heikkinen K, Kuusisto A, Virtanen H, Leino-Kilpi H. Surgical patient education: assessing the interventions and exploring the outcomes from experimental and quasiexperimental studies from 1990 to 2003. Clinical Effectiveness in Nursing 2004; 8: 81-92.

Indexing Status

Subject indexing assigned by CRD

MeSH

Attitude to Health; Health Policy; Patient Education as Topic; Patients; Physician-Patient Relations

AccessionNumber

12005008270

Database entry date

31/03/2006

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

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