Anesthesia ‘Decision Aids’ to Engage Patients When There is No ‘Best’

Summary 

Anesthesia decision aids are brochures that are specially designed to walk patients through the process of determining whether they would prefer a regional or general anesthetic technique for surgery. Designed for use only when there is no medically "best" option, these aids can help anesthesia providers engage patients in the shared decision-making that is becoming a cornerstone of patient-centered care.

Anesthesiologists and nurse anesthetists have short enough periods of face-to-face interaction with patients perioperatively that the concept of patient engagement might seem like a peripheral, if not foreign, aspect of anesthesia practice.

But patient engagement as a corollary of healthcare's shift toward patient-centered care is gaining traction, even within a specialty with so many "non-patient-facing" clinicians. It's an aspect of the perioperative surgical home, the comprehensive, collaborative model that is beginning to take hold within anesthesia. It's also part of the larger transition to value, reflected in quality reporting and trends such as the use of retail-style, star-based clinician ratings on Physician Compare and other sites.

As James R. Mesrobian, MD, a board member of the American Society of Anesthesiologists (ASA), noted in a session on patient satisfaction with anesthesia care at the ASA practice management conference, "We don't know where the future lies, but service is increasingly a part of what we do."

Involving patients in shared decision-making about their care is an aspect of that service. A multiyear survey of patients published in the New England Journal of Medicine found that respect for their values and preferences, and high quality education and information, are among the aspects of care that patients value the most. "In order to practice patient-centered care, healthcare providers need to engage in shared decision-making with patients," anesthesiologist Karen B. Domino, MD, MPH, of the University of Washington, Seattle, said in a 2017 ASA Monitor article. Anesthesia decision aids—specially-designed informational brochures on "preference sensitive" anesthesia techniques, including peripheral nerve blocks and epidural or spinal anesthesia—can help by guiding patients through the process of making informed choices.

Patients often have preferences about their care but don't speak up because they don't want to seem demanding, Dr. Domino said. This is probably especially true in anesthesia, where patients are often meeting their anesthesiologist or nurse anesthetist for the first time shortly before surgery. "Without engaging patients, we will never know their concerns and preferences," she said.

Anesthesia decision aids are designed to be used only when there is no medically "best" choice, i.e., when the best choice is what the patient prefers based on an understanding of the risks and benefits. Unlike standard patient education brochures, anesthesia decision aids are specifically designed to walk patients through the decision-making process.

Evidence suggests that they help patients. A 2014 review of 115 trials in various specialties found that decision aids improved patients' understanding of treatment options and risks, and helped them take a more active role in decisions regarding their care. A study presented at the 2015 ASA scientific meeting of two regional anesthesia decision aids showed that, compared to patients who did not receive them, the aids increased knowledge about regional anesthesia and patient engagement during the clinic visit, but that reading the information about risks didn't make patients more anxious about anesthesia (see chart below).

Copyright ©2015 American Society of Anesthesiologists

The regional anesthesia decision aids are available to ASA members for download here.

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