Psychology works for Presurgical Preparation

"You need surgery". Those words can quickly raise fears regarding pain, health, body damage or disfigurement, limited function, complications or even death. While the skill of the surgical team is extremely important to the outcome of any surgical procedure, other aspects of the process, including the patient’s psychological preparation, are also key to a good recovery. Physicians must help patients understand what will happen and the possible consequences before any surgery. In today’s time-pressured world of medicine and health care, preparing patients for the challenges of surgery has become an important component of overall surgery care. This issue is now more important than ever because recent health care reforms that emphasize efficiency and cost-effectiveness have resulted in shorter hospital stays for all surgical procedures. These changes have increased the number of ‘same-day’ surgeries (admission and surgery with no overnight stay). The fast-paced admission process can leave little time to prepare the patient for surgery later in the same day.

What is presurgical preparation?
"Presurgical preparation" is a common term used to describe a health care service in which important surgery information is provided to the patient some time before they are admitted. In general, most presurgical programs supply information on:

1) when the person should arrive at the hospital

2) where they should register or check-in

3) what they should bring with them (especially if they are staying overnight)

4) the procedure they are going to have, which is covered in detail by the surgeon during presurgical assessment

5) pre and postsurgical medications, such as the anesthetic and pain medication

6) what the patient can expect to feel like after the surgery

7) what the patient can do after the surgery that will help with recovery (e.g., self-care duties and related postsurgical exercise programs)

8) how long the average person is in hospital before leaving to return home

9) tips on how to prepare at home for the recovery period after discharge from hospital (depending on the patient’s level of postsurgical physical and psychological functioning)

10) a "go home" plan, or in other words, someone to support the patient when they leave the hospital and when they arrive home

What approaches are commonly used in presurgical preparation?
Just as there are differences in the amount of presurgical information supplied, there is also an assortment of methods used to deliver such programs. For example, programs may involve individual or group psychoeducational meetings with the physician or nurse or both, information handouts delivered by mail, video taped information, and websites to deliver this important information. Health care staff has worked to develop ways to make the information easy for people to understand and use. It is important to remember that not all surgeries may be able to use a presurgical preparation program, as is the case of emergency surgeries. Surgeries that are planned and scheduled in advance (i.e., elective surgery) most often use presurgery information programs.

What can presurgical preparation do for me?
This psychological preparation for the procedure and recovery has been shown to assist patients in dealing more effectively with surgery. That is, presurgical preparation has been associated with fewer complications, greater patient satisfaction, shorter time in hospital, and more positive psychological well-being. Presurgical preparation programs have also been shown to be effective in reducing pain, discomfort, and anxiety, as well as ensuring that patients follow self-care plans after the procedure.

Important components of presurgical preparation.
Presurgical preparation appears to help individuals know what to expect and learn how to be more actively involved in their own recovery. It is important to note that the positive effects of this type of preparation seem to be the result of improved patient interaction with the health care staff following surgery, and better use of self-care behaviors (e.g., deep breathing, coughing, relaxation, exercises). The preparation process can help surgery patients to communicate their expectations, fears, and ability to manage distress and pain associated with their surgery, which can then help the health care team respond better to their needs. Patients who are less active in their postsurgical recovery may not experience as great a benefit from presurgical preparation. Indeed, some patients find the health care setting to be quite frightening and feel that they are unable to be part of the recovery "effort".

The future?
Presurgical preparation is a major part of the surgical experience for many Canadians and it has been shown to be an effective aid in helping people on their way to better recoveries. It helps the individual gain a better understanding of what to expect, and how to best assist in the recovery process. It also provides information to reassure patients regarding common fears and concerns. Psychologists and other health care personnel are continually looking for ways to better assist patients in preparing for surgery, given the benefits that have already been identified through clinical research. Recent work to improve presurgical preparation has involved interactive computer services. For example, Computer Assisted Instruction (CAI) may prove to be better than written materials, as preliminary research suggests it can improve patient understanding of and satisfaction with the surgery process. Such programs include an audio taped script along with video, still pictures, and animated graphic segments to prepare the patient for the upcoming surgery. These programs also allow the individual to personally ‘tailor’ the level and complexity of information needed. New and innovative methods of delivering presurgical preparation programs continue to be explored in efforts to improve quality of care for patients.

Consultation with or referral to a registered psychologist can help guide you as to the use of these therapies. For a list of psychologists in your area, please press here.

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