Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: Poor health literacy is associated with higher mortality rates and poor postoperative care. Free flap reconstruction of the head and neck is highly complex and comprehensive patient education is crucial for more informed decision making, better understanding of the procedure, improved expectations and preparation for the postoperative period.
Objective: We aim to determine the effect of adjunct preoperative education visits with nurse practitioners prior to free flap reconstruction on patient understanding and comfort with their surgical procedure and post-operative expectations.
Design, Setting, Participants: This is a prospective study comparing patients who received pre-operative nurse practitioner (NP) education visits prior to free flap reconstruction and those who did not. Both cohorts received pre-operative and post-operative surveys ([1] European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC)- QLQ- INFO25 validated survey, [2] institutional survey regarding free flap education) to identify any differences in understanding of the procedure, expectations, and recovery. Surveys were conducted at 3 potential timepoints depending on the cohort: preoperatively after visit with operative surgeons, but before NP visits, after NP visit, and at the first postoperative visit. Postoperative complications and demographics were obtained from the electronic medical record. The study was conducted from February of 2024 to September of 2024 at a single academic institution. Chi-squared tests were performed to compare survey responses between cohorts. All analyses were performed using R Studio.
Results: 33 patients were included (63.5 years old, 63% Male, 81% White), of which 21 had pre-operative NP education visits. There were no differences in the total scores of the EORTC-QLQ survey pre-operatively between patients who did and did not have NP visits. Likewise, patients who had NP visits did not show a significant difference in EORTC-QLQ scores prior to and after their NP visit (p>0.9). At baseline prior to surgery and NP visit (if applicable), patients who had NP visits expected to be in the hospital for a longer period. Patients who had an NP visit were more likely to have knowledge of a tracheostomy compared to those who did not (95% and 64%, p=0.042). Patients who had an NP visit demonstrated an improvement in knowledge of free flap reconstruction following the NP visit (90% vs 57%, p=0.005). Postoperatively, patients who had an NP visit were more likely to report feeling prepared for their surgery compared to those who did not (74% vs 50%, p=0.036).
Conclusion: Our data suggests that surgeons are having thorough discussions with their patients prior to surgery and baseline knowledge of their procedure was present. The addition of NP visits for deliberate education on their hospital course, procedure, and postoperative course does enhance their understanding of free flap reconstruction and expectations for their surgery.