POWER to the people: A novel intervention to improve patient understanding in the surgical clinic

As surgeons we often suffer the privilege of meeting a patient on the worst day of their life. Our jobs necessitate the need for us to play the role of counsellor, comforter, empath, and advisor. All these skills are in addition to our classical tasks of clinician and operator. The realities of modern clinical practice are that we are far better at accounting for, and managing the human, or non-technical, aspects of clinical practice than we were in the bygone era. The caveat is that we are attempting to do so in a world where we have little to no time to spare. We are managing the complexities of an individual patient on multiple fronts, whilst attempting to navigate the needs of an ever-straining healthcare system. Modern clinical practice is an ever-growing field of complexity, and change. As clinicians, we attempt to navigate and synthesise this into a digestible format for our patient’s. Despite best effort’s, the wide consensus in the literature is that patients will typically remember 20-40% of what is discussed in a clinical encounter; however, of this figure, half of the information is remembered incorrectly.1-4 The reasons for this are multifactorial, however, it is hardly surprising that if you were to tell a person ‘you have cancer,’ the next pieces of information that you convey are not well remembered.

This challenge is one that has been tackled on a few fronts. Initially, the target for intervention was the surgeon. A large body of literature evaluated communication workshops, non-technical skills coaching, and various other clinician focussed interventions.5-7 These demonstrated merit; however, uptake has been poor. The primary reason for such, comes down to limitations of time. Surgeons are swamped with contact hours, training requirements, overflowing clinics, and overbooked theatre lists. Interventions targeting the individual require time and money to implement – both of which are scarce in the health sector. The second front involves implementing interventions to improve patient engagement in the therapeutic relationship. These patient targeted interventions improve patient knowledge and reduce decisional conflict.8

One such intervention is a Question Prompt List. This is a document given to a patient prior to a clinical encounter which contains a set list of questions that may be important to a patient. It serves as a tool to enable a patient to organise their thoughts and seek clarity about their healthcare issues during moments of high stress during the clinical encounter. This specific Question Prompt List, the POWER form (Personal Outpatient Worksheet and Educational Reference) consists of five prompts. (Figure 1). It is given to the patient before their clinical encounter and they are encouraged by their clinical team to ensure they understand these points and ask these, or any other questions, whilst with their surgeon. Our RCT evaluated use of the POWER form compared with standard care in the General Surgical Outpatient Clinic. It demonstrated that use of the POWER form improved patient recall by 56% (p<0.001) when compared with standard care. It also improved shared decision making and reduced decisional conflict. Use of the form has no impact on the duration of the clinical encounter. It is an intervention that can improve patient understanding without adding an additional burden to the already time poor surgeon.

The form can be adapted to suit any hospital by using free online editing platform Canva (link below). The only cost of implementation is printing.

Next steps in this field of research will involve evaluating the use of this tool in an inpatient setting and application across broader surgical specialties. It is a promising intervention that costs little to implement.