| Effect of Patient Decision Aids on Choice Between Sugammadex and Neostigmine in Surgical Patients Under General Anesthesia: A Multicenter Randomized Controlled Trial |
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Li-Kai Wang1,2, Yao-Tsung Lin1,2, Jui-Tai Chen3,4, Winnie Lan5, Kuo-Chuan Hung1,2, Jen-Yin Chen1, Kuei-Jung Liu3, Yu-Chun Yen6, Yun-Yun Chou7, Yih-Giun Cherng3,4, Ka-Wai Tam7,8,9,10 |
1Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
2Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
3Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
4Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
5Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
6Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
7Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
8Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
9Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
10Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan |
Corresponding author:
Yih-Giun Cherng, Tel: 886-2-22490088 ext.8860, Fax: 886-2-22490088 ext.2,
Email: stainless@s.tmu.edu.tw
Ka-Wai Tam, Tel: 886-2-22490088 ext.8860, Fax: 886-2-22490088 ext.2,
Email: kelvintam@h.tmu.edu.tw
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Received: 26 September 2022 • Revised: 22 November 2022 • Accepted: 4 December 2022 |
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| Abstract |
Background
Shared decision-making using patient decision aids (PtDAs) has been established for more than a decade, but few studies have evaluated its efficacy in Asian countries. We evaluated the application of PtDAs in a decision conflict between two muscle relaxant reversal agents—neostigmine and sugammadex—and performed sequential analysis for hospital location and operating room turnover rate.
Methods
This two-group, outcome assessor–blind, randomized controlled trial included 3132 surgical patients from two medical centres, admitted between March 2020 and August 2020. The patients were randomly divided into classical explanation and PtDAs-assisted explanation groups in preanesthesia consultations. Their clinicodemographic characteristics were analysed to identify the variables influencing their choice of reversal agent. On the day of preanesthesia consultations, the patients’ decision-making difficulties were assessed using a four-item SURE scale. The operating turnover rate were evaluated according to the anesthesia records.
Results
Compared with the classical group, the patients in the PtDAs group felt more confident about receiving sufficient medical information (P < 0.001), were better informed about advantages and disadvantages of the medications (P < 0.001), had superior understanding of benefits and risk of their options (P < 0.001), and had a firm attitude toward their choices (P < 0.001). Moreover, the PtDAs group had a significantly greater tendency to choose sugammadex over neostigmine (P < 0.001).
Conclusions
PtDAs intervention in preanesthesia consultations provided surgical patients clear knowledge and better support. PtDAs should also be made available in other medical fields to enhance shared clinical decision-making. |
| Key Words:
anesthesia; neostigmine; sugammadex; shared decision-making; patient decision aids; decision conflicts |
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