A Survey of Surgical Patients' Perspectives and Preferences Towards General Anesthesia Techniques and Shared-decision Making

Bethany R. Tellor Pennington; Mary C Politi; Arbi Ben Abdallah; Allison M. Janda; Ingrid Eshun-Wilsonova; Nastassjia G. deBourbon; Lilly Siderowf; Heidi Klosterman; Sachin Kheterpal; Michael S. Avidan

Disclosures

BMC Anesthesiol. 2023;23(277)

Abstract and Introduction

Abstract

Background: The decision about which type of general anesthetic to administer is typically made by the clinical team without patient engagement. This study examined patients' preferences, experiences, attitudes, beliefs, perceptions, and perceived social norms about anesthesia and about engaging in the decision regarding general anesthetic choice with their clinician.

Methods: We conducted a survey in the United States, sent to a panel of surgical patients through Qualtrics (Qualtrics, Provo, UT) from March 2022 through May 2022. Questions were developed based on the Theory of Planned Behavior and validated measures were used when available. A patient partner who had experienced both intravenous and inhaled anesthesia contributed to the development and refinement of the questions.

Results: A total of 806 patients who received general anesthesia for an elective procedure in the last five years completed the survey. 43% of respondents preferred a patient-led decision making role and 28% preferred to share decision making with their clinical team, yet only 7.8% reported being engaged in full shared decision making about the anesthesia they received. Intraoperative awareness, pain, nausea, vomiting and quickly returning to work and usual household activities were important to respondents. Waking up in the middle of surgery was the most commonly reported concern, despite this experience being reported only 8% of the time. Most patients (65%) who searched for information about general anesthesia noted that it took a lot of effort to find the information, and 53% agreed to feeling frustrated during the search.

Conclusions: Most patients prefer a patient-led or shared decision making process when it comes to their anesthetic care and want to be engaged in the decision. However, only a small percentage of patients reported being fully engaged in the decision. Further studies should inform future shared decision-making tools, informed consent materials, educational materials and framing of anesthetic choices for patients so that they are able to make a choice regarding the anesthetic they receive.

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Abstract and Introduction
Background
Methods
Results
Discussion
Conclusions
References

Table 1. Demographics
Demographic Variable	N (%)
Gender
Male	409 (50.7)
Female	392 (48.6)
Non-binary	5 (0.6)
Age
18–35 years	351 (43.6)
36–50 years	275 (34.1)
51–65 years	123 (15.3)
65 + years	57 (7.1)
Race and Ethnicity (select all that apply)
White or Caucasian	551 (68.4)
Black or African American	141 (17.5)
Hispanic	81 (10.1)
Asian	25 (3.1)
American Indian or Alaska Native	15 (1.9)
Multi-Racial	9 (1.1)
Native Hawaiian or Pacific Islander	3 (0.4)
Other	61 (7.6)
Prefer not to answer	1 (0.1)
Education
Less than high school	5 (0.6)
Some high school	22 (2.7)
High school diploma or GED	218 (27.1)
Some college or technical training	246 (30.5)
A college degree	243 (30.2)
A graduate or professional degree	71 (8.8)
Prefer not to answer	1 (0.12)
Health Insurance
Medicaid	243 (30.2)
Medicare	164 (20.4)
Private Insurance	316 (39.2)
No Insurance	58 (7.2)
Other	19 (2.4)
Prefer not to answer	6 (0.7)
Current Living Community
Rural	213 (26.4)
Urban	29 (36.2)
Suburban	300 (37.2)
Prefer not to answer	1 (0.1)

Table 2. Important factors assessed by Age with statistically significant results
	Age ≤ 50 years Mean (SD)	Age > 50 years Mean (SD)	P value*
Do not wake up during surgery	4.4 (0.95)	4.6 (0.71)	0.006
Does not cause nausea or vomiting	4.1 (0.99)	4.3 (0.89)	0.078
Does not make you feel groggy or confused	3.7 (1.09)	4.0 (1.03)	0.012
Allows you to leave the hospital faster	3.9 (1.11)	4.1 (1.00)	0.054
Least expensive option	3.6 (1.23)	3.3 (1.40)	0.060
Contributes the least to climate change	3.5 (1.25)	3.0 (1.40)	< 0.001

*Bonferroni corrected P values were calculated with the unpaired Student's t-test

Table 3. Important factors assessed by Race with statistically significant results
	White Mean (SD)	Black Mean (SD)	Other Mean (SD)	P value*
Do not wake up during surgery	4.6 (0.76)	4.1 (1.06)	4.2 (1.11)	< 0.001
Does not cause nausea or vomiting	4.2 (0.92)	3.9 (1.12)	4.1 (0.99)	0.018
Contributes the least to climate change	3.2 (1.32)	3.7 (1.19)	3.4 (1.29)	0.024

*Bonferroni corrected P value for the F statistic

Table 4. Previous Surgical/Anesthesia Experiences assessed by Age
	≤ 50 Yrs (n = 626) n (%)	> 50 Yrs (n = 180) n (%)	P Value*
Feeling groggy or confused when you woke up	315 (50.3)	61 (33.9)	< 0.001
Nausea and/or vomiting	169 (27.0)	24 (13.3)	< 0.001
Inability to be as physically active as you were at baseline during the first week of your recovery period	123 (19.6)	19 (10.6)	0.030
Inability to sleep well during the first week of your recovery period	101 (16.1)	12 (6.7)	0.006
Difficulty returning to work or usual home activities	101 (16.1)	11 (6.1)	< 0.001
Memories of waking up during surgery	67 (10.7)	15 (8.3)	1.000

*Bonferroni corrected P values were calculated with the unpaired Student's t-test

Table 5. Beliefs about General Anesthesia
	Intravenous (IV), n (%)	Inhaled gas, n (%)	Both are equal, n (%)	Unsure, n (%)
Characteristics of Anesthesia Type
Safer	220 (27.3)	161 (20.0)	318 (39.5)	107 (13.3)
More Nausea/Vomiting	204 (25.3)	237 (29.4)	206 (25.6)	159 (19.7)
More likely to lead to a feeling of general well-being	221 (27.4)	227 (28.2)	213 (26.4)	145 (18.0)
More likely associated with quicker time to recovery	240 (29.8)	252 (31.3)	174 (21.6)	140 (17.4)
Most commonly given	343 (42.6)	217 (26.9)	174 (21.6)	72 (8.9)
Higher risk of intraoperative awareness	172 (21.3)	306 (38.0)	161 (20.0)	167 (20.7)
More likely to contribute to climate change	100 (12.4)	322 (40.0)	103 (12.8)	281 (34.9)