Patient Education in the Surgical Brigade Setting: Developing a Low-Resource, High-Impact Intervention for Total Joint Replacement Patients.

Abstract

Background: Temporary surgical brigade trips to deliver international surgical care are increasingly common. Many brigade programs have begun to improve their quality and transparency by collecting and publishing data on outcomes and complications, but few have examined their own patient education practices. Research is needed to explore challenges to and optimal modes of delivering perioperative education in these settings to patients with diverse backgrounds, education levels, and cultural contexts. We demonstrate the use of validated methods to rigorously evaluate and then improve patient education materials for a total joint replacement (TJR) surgical brigade. Methods: We evaluated the patient education practices of Operation Walk (OpWalk), a TJR surgical brigade in the Dominican Republic. We first estimated the readability of several web-based Spanish-language patient education resources related to TJR. We then undertook a systematic evaluation of the suitability of OpWalk’s existing patient education materials. Finally, we used validated methods to re-design the patient education materials to be more appropriate based on patient demographics and prior studies. We intend to validate our materials with the target population in spring 2016. Results: Our readability estimates demonstrated that Spanish-language patient education materials on total hip replacement (THR) from the American Academy of Orthopaedic Surgeons (AAOS) and the National Association of Orthopaedic Nurses (NAON) were written at the 12th and 9th grade levels, respectively. Existing OpWalk patient education materials required a 7th grade reading level but lacked suitability as measured by the Suitability Assessment of Materials (SAM). The re-designed patient discharge materials required 3rd grade reading skills and had superior suitability on the SAM scale. Comprehension and acceptability will be tested through interview interviews with Dominican patients in spring 2016. Conclusion: The AAOS and NAON THR resources we evaluated are not appropriate for many Hispanic patients in the US or for Dominican OpWalk patients. The existing OpWalk patient education materials required reading skills above those of at least 40% of OpWalk patients and lacked suitability based on principles of educational design. The revised materials are objectively more appropriate and approval by the target population is pending. Surgical brigades have an ethical imperative to provide patients with appropriate perioperative education to optimize outcomes and post-operative support. Translated discharge materials from hospitals in developed countries are not likely to constitute adequate or appropriate patient education for surgical brigade patients. More research is needed and brigade programs should work with patients to develop educational materials which are suitable and effective.