Factors Affecting Patient Readiness and Surgical Outcomes in Preoperative Patients: A Model Testing Study

Gian Carlo S. Torres PhD, RN

Background: Surgery is a common approach to manage various disorders among patients across the lifespan. However, being an unkown and complex procedure for most, it may lead to stress and anxiety, both to the patient and their significant others. Nurses, being at the forefront of patient care, must ensure adequate preparation to promote patient readiness. Albeit studies claim the importance of readiness, there is paucity of evidence supporting such notion.
Purpose: This study developed a structural model that reflects the relationship of the factors that affect patient readiness and how readiness affects surgical outcomes.

Methods: Utilizing structural equation modeling, a descriptive-correlational study was conducted among 376 consecutively-selected adult surgical patients from four tertiary hospitals. Consenting respondents were approached preoperatively utilizing preoperative factors assessment (surgical risk, type of surgery), anxiety scores (Preoperative intrusive thoughts inventory) and health literacy (Newest Vital Signs ) including assessment of preoperative patient readiness (Preoperative Assessment of Readiness Tool). while post operative patients were assessed on their surgical pain and use of rescue analgesics, occurrence of complications and patient experience (Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey) . All instruments were translated and back translated using Filipino language , underwent validation and pretesting with acceptable reliability scores.

Results/findings: The emerging model showed good fit indices after appropriate model trimming: χ2/df=0.75, RMSEA=0.00, GFI=0.99, CFI=1.00, and PNFI=0.50. Among the antecedents, results showed that the type of surgery (curative) influences patient readiness (β=0.09, p=0.004), surgical complications (β=0.02, p=0.004) and rescue pain medication use (β=–0.06, p=0.015). Surgical risk also influences surgical complications (β=0.04, p=0.022) and rescue pain medication use (β=0.08, p=0.004). Health literacy influences patient readiness (β=–0.07, p=0.007), rescue pain medication use (β=–0.20, p=0.004), and post-operative pain (β=–0.23, p=0.004). Further, preoperative anxiety affects patient readiness (β=–0.25, p=0.004), post-operative pain (β=0.18, p=0.004), and surgical satisfaction (β=–0.09, p=0.004). Results also confirmed the mediating role of patient readiness in the influence of the type of surgery, health literacy, and preoperative anxiety to different surgical outcomes. The type of surgery to be performed, and the patients’ health literacy and pre-operative anxiety levels affect the latter’s readiness for the operation. Patient readiness influences surgical outcomes such as development of post-operative complications, need for rescue pain medications, and the degree of client satisfaction. Readiness is also an important mediator that affects outcomes observed after surgery. Patient readiness is an essential element that healthcare providers must establish before surgical procedures as it can lead to a patient who is more in control, can appropriately acknowledge his or her pain experience, knows when to ask for additional pain medication, and are generally more satisfied with their surgical experience.

Conclusion: The model developed is a parsimonius and theoretically-sound, which reflects that readiness is a significant factor that can promote the development of better surgical outcomes. Further, adequate patient readiness can positively mediate the influence of anxiety and health literacy to have better surgical outcomes. Therefore, it is essential for healthcare providers to develop appropriate programs that are patient-specific and individualized surgical care to ensure adequate preparation among surgical patients.

Keywords: 

Patient Readiness, Health Literacy, Surgical Outcomes, Patient Experience, Structural Equation Modeling
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