ABSTRACT
OBJECTIVES: Acute Pain Services (APS) are well-established worldwide; however, their availability and use in cardiac surgery units are less widespread and, even where present, may be provided less consistently. The authors undertook this survey to assess the current organization of Cardiac Acute Pain Services (CAPS) in Canada. DESIGN: This was a prospectively administered survey. SETTING: This study included all centers in Canada that conducted adult cardiac surgery. PARTICIPANTS: The participants were anesthesiologists. INTERVENTION: A 20-item questionnaire covered the demographics, functioning and APS structure. RESULTS: The authors achieved a response rate of 100% with completed questionnaires from all 31 centers. Ten centers (32.3%) stated that they had a dedicated CAPS, 9 centers (29%) stated that they did not have an APS, and 12 centers (38.7%) had APS but no CAPS. At the time of the survey for the 10 centers with CAPS, 3 of the CAPS had a physician-run model, 4 had a combined physician and nurse service, and 1 used a combination of protocols, intensivists, and nurse practitioners. Nine centers had an anesthesiologist assigned to daily acute pain rounds. Only in 2 of 10 centers with CAPS were more than 50% of their cardiac surgery patients receiving care. In general, postoperative pain management was a protocol-driven activity. CONCLUSIONS: CAPS are varied in both structure and functioning. Further work is required both at the institutional and the national levels to improve the postoperative care and the pain-related outcomes of patients undergoing cardiac surgery.
Subject(s)
Acute Pain/epidemiology , Cardiac Surgical Procedures/adverse effects , Pain Management/methods , Pain Measurement/methods , Pain, Postoperative/epidemiology , Surveys and Questionnaires , Acute Pain/diagnosis , Acute Pain/therapy , Anesthesiologists/statistics & numerical data , Canada/epidemiology , Humans , Pain Management/statistics & numerical data , Pain, Postoperative/diagnosis , Pain, Postoperative/therapy , Prospective StudiesABSTRACT
This project aimed to co-develop and pilot an intervention plan to support shared decision-making (SDM) for patients considering a ventricular assist device (VAD), their caregivers and the health care team. The project involved a focus group with patients and caregivers to explore their decision-making needs along with regular participation in team meetings resulting in the creation of a decision aid. The decision aid answered needs expressed by patients and caregivers, as well as the team's initial needsfor informational support, optimization of information exchange and process standardization. A workshop on SDM was also conducted to increase competence toward this approach and the use of the decision aid. This project is timely and relevant given the increase in VAD implantation in Canada. The intervention could also be applicable to other decision-making situations in which active participation can improve the quality of the decision process.
Subject(s)
Caregivers , Decision Making , Decision Support Techniques , Heart Failure/therapy , Heart-Assist Devices , Prosthesis Implantation , Canada , Female , Focus Groups , Humans , Male , Needs Assessment , Patient Participation , Pilot Projects , Quality Improvement , Severity of Illness Index , Stress, PsychologicalABSTRACT
Several studies have outlined the impact of patient's beliefs on their level of pain relief after surgery and have underlined that misconceptions are barriers to effective pain relief. The aim of this survey was to evaluate the beliefs of the patients to help create a specifically adapted pain education program. After ethics approval, all patients scheduled to undergo cardiac surgery of any kind were approached and asked to complete a voluntary, non-nominative questionnaire that included the Barriers Questionnaire and the Screening Tool for Addiction Risk (STAR) Questionnaire. All completed questionnaires were collected from the charts every evening or the morning before surgery. Of 564 patients scheduled for surgery, 379 patients (67.5%) returned questionnaires. The average age was 60.3 years, and 66.0% were male. Results of the Barriers Questionnaire showed that 31% of patients were in strong agreement that "it is easy to become addicted to pain medication," 20% agreed that "good patients do not speak of their pain," and 36% believe that "pain medication should be saved in case pain worsens." Little or no gains have been made in decreasing misconceptions related to the treatment of pain. This study underlines the considerable need for and absolute necessity to provide pain education to patients undergoing cardiac surgery.
