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      Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention

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          Abstract

          Introduction

          Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery.

          Methods and analysis

          100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery.

          Ethics and dissemination

          Ethical approval has been obtained from the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results.

          Trial registration number

          ChiCTR-IOR-15006971.

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          Most cited references30

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          Validation of the Chinese-Cantonese version of the hospital anxiety and depression scale and comparison with the Hamilton Rating Scale of Depression.

          The aim of this study was to validate the Chinese-Cantonese version of the Hospital Anxiety and Depression Scale (HADS) and to compare it with the Hamilton Rating Scale of Depression (HRSD) as a screening tool for depressive disorders in general hospital in-patients. The Chinese-Cantonese version of the HADS was administered to general hospital in-patients seen on a consultation basis, and psychiatric diagnoses were made according to DSM-III-R. The subjects were further rated independently with the HRSD. The Chinese-Cantonese version of the HADS was found to have good internal consistency and external validity, with favourable sensitivity and specificity for screening for psychiatric disorders. However, its performance was marginally inferior to that of the HRSD. The scale also performed poorly in identifying major depression. The HADS has limitations with regard to identification of depressive disorders. However, despite its shortcomings, it remains one of the best paper-and-pencil tests for screening psychiatric disorders in the medically ill.
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            Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey.

            To refine the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey and develop a validated method for scoring the instrument. Instrument development study, using data from two prospective cohort studies. Intensive care units in seven university-affiliated hospitals (six Canadian, one United States). Family members of ICU patients. Based on a priori criteria, items were tagged for potential removal and discussed with the FS-ICU developers. Factor analysis was used to test the conceptual structure of the instrument and develop a scoring method based on scales and subscales. The new scoring method was validated in the U.S. cohort using the Quality of Dying and Death (QODD) instrument and nurse-assessed quality indicators. A total of 1,038 family members completed the FS-ICU across seven sites. Fifteen items were initially tagged for possible removal. After consensus with the developers, ten items were dropped (and 24 were retained in the final instrument). Factor analysis explained 61.3% of the total variance using a two-factor model. The first factor pertained to satisfaction with care (14 items). The second factor encompassed satisfaction with decision making (10 items). A scoring method was developed based on this conceptual model. In validity testing, the FS-ICU was significantly correlated with the Family-QODD total score (Spearman's .56, p < .001) as well as individual QODD items such as quality of care by all providers (.64, p < .001). The FS-ICU also correlated significantly with multiple nurse-assessed quality indicators. The shortened FS-ICU measures two main conceptual domains-satisfaction with care and satisfaction with decision making. Scores on the FS-ICU show good validity against other indicators of ICU quality. The instrument holds promise as a useful outcome measure in studies that attempt to improve this component of ICU care.
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              Measuring family satisfaction with care in the intensive care unit: the development of a questionnaire and preliminary results.

              To develop and test the feasibility of administering a questionnaire to measure family members' level of satisfaction with care provided to them and their critically ill relative. To develop the questionnaire, existing conceptual frameworks of patient satisfaction, decision making, and quality of end-of-life care were used to identify important domains and items. We pretested the questionnaire for readability, clarity, and sensibility in 21 family members and 16 professionals. To assess validity, we measured the correlation between satisfaction with overall care and satisfaction with decision making. To assess the reliability of the questionnaire, we administered the questionnaire to next of kin of surviving patients on discharge and 7 to 10 days later. Questionnaires were mailed out to 33 family members of nonsurvivors; 24 were returned completed but only 22 (66%) were usable.Twenty-five family members of eligible surviving critically ill patients participated in the test-retest part of this study. Of the 47 respondents, 84% were very satisfied with overall care and 77% were very satisfied with their role in the decision making. There was good correlation between satisfaction with overall care and satisfaction with decision making (correlation coefficient =.64). The assessment of overall satisfaction with care was shown to be reliable (correlation coefficient =.85). This questionnaire has some measure of reliability and validity and is feasible to administer to next of kin of critically ill patients. Copyright 2002 by W.B. Saunders Company
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                22 June 2016
                : 6
                : 6
                : e011341
                Affiliations
                [1 ]Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong , Shatin, Hong Kong
                [2 ]Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong , Shatin, Hong Kong
                Author notes
                [Correspondence to ] Professor Anna Lee; annalee@ 123456cuhk.edu.hk
                Author information
                http://orcid.org/0000-0003-3593-9141
                http://orcid.org/0000-0003-2864-0045
                http://orcid.org/0000-0002-5823-3435
                Article
                bmjopen-2016-011341
                10.1136/bmjopen-2016-011341
                4932258
                27334883
                b11bc762-e3a6-46ea-8987-f43d1f6577f6
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 29 January 2016
                : 28 May 2016
                : 3 June 2016
                Categories
                Intensive Care
                Protocol
                1506
                1707
                1737

                Medicine
                Medicine

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