Abstract
Objective
We reviewed the impact of the use of routine perioperative counselling on patients outcomes and experience when undergoing operative deformity correction for adolescent idiopathic scoliosis.
Methods
Between January 2006 and December 2008, 28 consecutive patients underwent operative deformity correction for adolescent idiopathic scoliosis. 26 of these were seen at the initial presentation to clinic by a voluntary counsellor with experience of a family member having undergone scoliosis correction after they had been identified as being likely to require operative intervention. Most patients were only seen once preoperatively by the counsellor but several were seen on multiple occasions. Most patients were offered the opportunity to meet a post-operative patient who had previously had scoliosis correction surgery. SRS 22 questionnaires were completed pre and post-operatively. All curves were classified using the Lenke classification and pre and post operative Cobb angles were recorded. All patients and their parents were followed up at a mean interval of 3 years with a telephone survey regarding how they felt the input from a counsellor impacted on their experience.
Results
6 patients were lost to follow up. Of those contacted both patients and their parents were interviewed. On a scale from 0-5 marking how useful the initial consultation with a counsellor was, the median rating was 4. No significant difference was found between patients answers and their parents. The most common response regarding the impact of the counselling was that after being shocked and distraught by the prospect of surgery, meeting the counsellor was very “reassuring.” Only 7 patients took the opportunity to meet a post-operative patient. However, all of those who did found the experience invaluable and rated the meeting as 5/5. The main reason given for not wishing to meet a post-operative patient was that patients were concerned it would make them more apprehensive. However, most patients who turned down this opportunity retrospectively felt it would have been useful. Many patients reported that they counselled teenagers in their local area or at school awaiting similar surgery, after they had recovered from their procedure. In spite of an overarching appreciation of the presence of a counsellor, there was no correlation between the consultation or further meetings with previous patients and whether patients and their families felt the perioperative period met their expectations. A majority of patients stated they were more than happy to meet pre-operative patients to help them to understand what to expect.
Conclusion
Perioperative counselling has subjective benefits for adolescent patients undergoing major spinal surgery although this is not true for all patients. For some patients, meeting a lay person in clinic for reassurance was invaluable. Patients are most likely to meet with former patients if they are from their local area. We would recommend that local networks of former patients be formed so that patients can easily access advice and support. We believe that social networking sites may be useful to facilitate this. Our results support the continued use of counselling at the time of clinic appointments and we seek to support the continued development of patient networks in a decentralised form.
Ethics Approval:
Audit service standard in trust
Interest Statement: None
