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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 9/2019

01-09-2019 | Reports of Original Investigations

Personalized perioperative medicine: a scoping review of personalized assessment and communication of risk before surgery

Authors: Emma P. Harris, MD, David B. MacDonald, MD, FRCPC, Laura Boland, MSc-SLP-C, PhD, Sylvain Boet, MD, PhD, Manoj M. Lalu, MD, PhD, FRCPC, Daniel I. McIsaac, MD, MPH, FRCPC

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 9/2019

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Abstract

Background

Personalized medicine aims to improve outcomes through application of therapy directed by individualized risk profiles. Whether personalized risk assessment is routinely applied in practice is unclear; the impact of personalized preoperative risk prediction and communication on outcomes has not been synthesized. Our objective was to perform a scoping review to examine the extent, range, and nature of studies where personalized risk was evaluated preoperatively and communicated to the patient and/or healthcare professional.

Methods

A systematic search was developed, peer-reviewed, and applied to Embase, Medline, CINAHL, and Cochrane databases to identify studies of individuals having or considering surgery, where a process to assess personalized risk was applied and where these estimates were communicated to a patient and/or healthcare professional. All stages of the review were completed in duplicate. We narratively synthesized and described identified themes.

Results

We identified 796 studies; 24 underwent full-text review. Seven studies were included; one communicated personalized risk to patients, four to a healthcare professional, and two to both. Cardiac (n = 2) and orthopedic surgery (n = 2) were the most common surgical specialties. Four studies used electronic risk calculators, and three used paper-based tools. Personalized preoperative risk assessment and communication may improve accuracy of information provided to patients, improve consent processes, and influence length of stay. Methodologic weaknesses in study design were common.

Conclusions

Personalized preoperative risk assessment and communication may improve patient and system outcomes. This evidence is limited, however, by weaknesses in study design. Appropriately powered, low risk of bias evaluation of personalized risk communication before surgery is needed.
Appendix
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Literature
1.
Schleidgen S, Klingler C, Bertram T, Rogowski WH, Marckmann G. What is personalized medicine: sharpening a vague term based on a systematic literature review. BMC Med Ethics 2013; 14: 55.CrossRefPubMedPubMedCentral
2.
Cesuroglu T, Syurina E, Feron F, Krumeich A. Other side of the coin for personalised medicine and healthcare: content analysis of ‘personalised’ practices in the literature. BMJ Open 2016; 6: e010243.CrossRefPubMedPubMedCentral
3.
Ginsburg GS, Phillips KA. Precision medicine: from science to value. Health Aff (Millwood) 2018; 37: 694-701.CrossRef
4.
King A, Bottle A, Faiz O, Aylin P. Investigating adverse event free admissions in Medicare inpatients as a patient safety indicator. Ann Surg 2017; 265: 910-5.CrossRefPubMed
5.
Grewal K, Wijeysundera DN, Carroll J, Tait G, Beattie WS. Gender differences in mortality following non-cardiovascular surgery: an observational study. Can J Anesth 2012; 59: 255-62.CrossRefPubMed
6.
Wijeysundera DN, Beattie WS, Austin PC, Hux JE, Laupacis A. Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort study. BMJ 2010; 340: b5526.CrossRefPubMedPubMedCentral
7.
Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013; 217: 833-42.e1-3.
8.
9.
Leclercq WK, Keulers BJ, Scheltinga MR, Spauwen PH, van der Wilt GJ. A review of surgical informed consent: past, present, and future. A quest to help patients make better decisions. World J Surg 2010; 34: 1406-15.
10.
Keulers BJ, Scheltinga MR, Houterman S, Van Der Wilt GJ, Spauwen PH. Surgeons underestimate their patients’ desire for preoperative information. World J Surg 2008; 32: 964-70.CrossRefPubMedPubMedCentral
11.
Taher T, Khan NA, Devereaux PJ, et al. Assessment and reporting of perioperative cardiac risk by Canadian general internists: art or science? J Gen Intern Med 2002; 17: 933-6.CrossRefPubMedPubMedCentral
12.
Gainer RA, Curran J, Buth KJ, David JG, Légaré JF, Hirsch GM. Toward optimal decision making among vulnerable patients referred for cardiac surgery: a qualitative analysis of patient and provider perspectives. Med Decis Mak 2017; 37: 600-10.CrossRef
13.
Mulley AG Jr. The role of shared decision making in achieving allocative efficiency in health systems. In: Elwyn G, Edwards A, Thompson R, editors. Shared Decision Making in Healthcare: Achieving Evidence-Based Patient Choice. 2nd ed. Oxford, UK: Oxford University Press; 2016 .
14.
Gattellari M, Ward JE. Will men attribute fault to their GP for adverse effects arising from controversial screening tests? An Australian study using scenarios about PSA screening. J Med Screen 2004; 11: 165-9.CrossRefPubMed
15.
Wijeysundera DN. Predicting outcomes: is there utility in risk scores? Can J Anesth 2015; 63: 148-58.CrossRefPubMed
16.
17.
Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169: 467-73.CrossRefPubMed
18.
Arksey H, O’Malley L. Scoping studies: towards a methodological framwork. Int J Soc Res Methodol 2005; 8: 19-32.CrossRef
19.
20.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 2016; 75: 40-6.CrossRefPubMed
21.
22.
Malenka DJ, Ross CS, Langner C, et al. Can a Customized quantitative informed consent document improve decision quality and be integrated into the routine process of care Circulation 2011; 4: P308 (abstract).
23.
Gainer R, Begum J, Wilson-Pease E, Hirsch G. A formalized shared decision making process with individualized decision aids improves comprehension and decisional quality among frail, elderly cardiac surgery patients. Can J Cardiol 2016; 32: S266-7.CrossRef
24.
MacDonald V, Arthur B, Parent S. The Vancouver General Hospital joint replacement rapid recovery program: optimizing outcomes through focused pathways. J Orthop Nurs 2005; 9: 95-102.CrossRef
25.
Punt IM, van der Most R, Bongers BC, et al. Improving pre- and perioperative hospital care: major elective surgery (German) Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 410-8.
26.
Miranne JM, Gutman RE, Sokol AI, Park AJ, Iglesia CB. Effect of a new risk calculator on patient satisfaction with the decision for concomitant midurethral sling during prolapse surgery: a randomized controlled trial. Female Pelvic Med Reconstr Surg 2017; 23: 17-22.CrossRefPubMed
27.
Aggarwal S, Stewart P, Eccersley J. Use of real time mortality risk assessment to inform standard of sugical care in a District General Hospital. Color Dis 2014; 116: 169.
28.
29.
Moonesinghe SR, Mythen MG, Das P, Rowan KM, Grocott MP. Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review. Anesthesiology 2013; 119: 959-81.CrossRefPubMed
30.
Oliver CM, Walker E, Giannaris S, Grocott MP, Moonesinghe SR. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. Br J Anaesth 2015; 115: 849-60.CrossRefPubMed
31.
Jelovsek JE, Chagin K, Brubaker L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol 2014; 123(2 Pt 1): 279-87.CrossRefPubMedPubMedCentral
32.
Ford MK, Beattie WS, Wijeysundera DN. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med 2010; 152: 26-35.CrossRefPubMed
33.
34.
Neuner-Jehle S, Senn O, Wegwarth O, Rosemann T, Steurer J. How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats. BMC Fam Pract 2011; 12: 15.CrossRefPubMedPubMedCentral
35.
Wegwarth O, Schwartz LM, Woloshin S, Gaissmaier W, Gigerenzer G. Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States. Ann Intern Med 2012; 156: 340-9.CrossRefPubMed
36.
Trevena LJ, Davey HM, Barratt A, Butow P, Caldwell P. A systematic review on communicating with patients about evidence. J Eval Clin Pract 2006; 12: 13-23.CrossRefPubMed
37.
Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996; 15: 361-87.CrossRefPubMed
38.
39.
Zikmund-Fisher BJ, Ubel PA, Smith DM, et al. Communicating side effect risks in a tamoxifen prophylaxis decision aid: the debiasing influence of pictographs. Patient Educ Couns 2008; 73: 209-14.CrossRefPubMedPubMedCentral
40.
Edwards AG, Naik G, Ahmed H, et al. Personalised risk communication for informed decision making about taking screening tests. Cochrane Database of Syst Rev 2013; 2: CD001865.
41.
Beggs T, Sepehri A, Szwajcer A, Tangri N, Arora RC. Frailty and perioperative outcomes: a narrative review. Can J Anesth 2015; 62: 143-57.CrossRefPubMed
42.
43.
Rodseth RN, Lurati Buse GA, Bolliger D, et al. The predictive ability of pre-operative B-type natriuretic peptide in vascular patients for major adverse cardiac events: an individual patient data meta-analysis. J Am Coll Cardiol 2011; 58: 522-9.CrossRefPubMed
44.
Nan J, Li J, Li X, Guo G, Wen X, Tian Y. Preoperative serum carcinoembryonic antigen as a marker for predicting the outcome of three cancers. Biomark Cancer 2017; 9: 1-7.CrossRefPubMedPubMedCentral
45.
Moulton BW, Pope TM. Emerging legal issues for providers in the US. In: Elwyn G, Edwards A, Thompson R, editors. Shared Decision Making in Healthcare: Achieving Evidence-Based Patient Choice. 2nd ed. Oxford, UK: Oxford University Press; 2016 .
46.
Barry MJ, Edgman-Levitan S. Shared decision making–pinnacle of patient-centered care. N Engl J Med 2012; 366: 780-1.CrossRefPubMed
47.
Hargraves I, LeBlanc A, Shah ND, Montori VM. Shared decision making: the need for patient-clinician conversation, not just information. Health Aff (Millwood) 2016; 35: 627-9.CrossRef
48.
Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns 2014; 94: 291-309.CrossRefPubMed
Metadata
Title
Personalized perioperative medicine: a scoping review of personalized assessment and communication of risk before surgery
Authors
Emma P. Harris, MD
David B. MacDonald, MD, FRCPC
Laura Boland, MSc-SLP-C, PhD
Sylvain Boet, MD, PhD
Manoj M. Lalu, MD, PhD, FRCPC
Daniel I. McIsaac, MD, MPH, FRCPC
Publication date
01-09-2019
Publisher
Springer International Publishing
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 9/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-019-01432-6

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