PERCEPTION OF PATIENTS ABOUT THE INFORMATION GIVEN IN PRE-OPERATIVE ANESTHESIA EVALUATION'S PERIOD

1. Lecturer, Prince Sultan Military College of Health Sciences (PSMCHS) Saudi Arabia. 2. Associate Professor, College of Medical, Sciences Technology, Alzaiem Alazhari University, Sudan. 3. Assistant Professor, College of Medical, Sciences Technology, Alzaiem Alazhari University, Sudan. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 April 2020 Final Accepted: 12 May 2020 Published: June 2020

One of the biggest challenges in Sudan was patient understandingin the field of anesthesia evaluation before surgery, and most patients suffer from finding enough about the clinic. Recent studies in Sudan have shown some apparent obstacles that anesthesiologists may face when dealing with this field, for example, an inappropriate declaration of guidelines Also, a lack of awareness of the advantages of pre-anesthesia evaluation. (Elnoor Tasneem and Khalid Elham, 2015) This study is investigating the association between patient perception and the information provided in the assessment of pre-operative anesthesia. The study hypothesized that the perception is low; many developing countries, such as Sudan, have difficulties in distributing adequate budgets, and health spending are deficient. As well as the inefficient use of available resources, mainly for administrative reasons, low economic performance, and population growth, leading to weak growth in health as well as the poor budget allocation and limited opportunities for excellent social services, including healthcare. (WHO | Regional Office for the Eastern Mediterranean, 2018) Sharing information and communication between patients and anesthesiologists is seen as an essential clinical function in the construction of a good doctor-patient relationship, which is the core and skill of the anesthesia. Patient satisfaction determined by the form of communication that happens. Reliableinformation is the starting point of shared understanding and confidence. (Begum, 2015). Several other studies have described patient satisfaction and acceptance to participate in the choice of surgical anesthesia care. Almost all patients who are aware of anesthesia options and who participate in the decision-making process are satisfied and feel the best respect, and most patients want asupportive role. (Hwang et al., 2014) The relationship between the doctor and the patient is significant for the anesthesiologist, who usually finds the patient just directly before the operation. Another problem is that the patient is unconscious while he/she under the care of an anesthesiologist.
The American Society of Anesthesiologists has brought out essential calibers for pre-anesthetic evaluation that suit patients come in for all methods of anesthesia. For many years, pre-operative assessment comprised of a group of "ordinary screening." many native and worldwide studies have examined the utility and the necessity for this information. (Baghaei Tehrani, 2017). Thus, pre-operative and anesthesia evaluation is critical to establish a good relationship with the patient. Family members should also be included during these patient meetings (as long as the patient does not object), (John F. Butterworth IV, David C. Mackey, 2013) In recentstudies, researchers found potential associations between many factors and measures of satisfaction. Research had seen in a standardized patient satisfaction using a phone survey consisting of 25 questions (1-10 rating scale) inquired about scheduling, parking, office staff, teamwork, wait-time, radiology, provider interactions/behavior, treatment, and follow-up communication. They found Potential associations between these factors' and primary outcome measures of satisfaction. However, many of the sources collect reluctant data on satisfaction in disclosing detailed information, which means there is still little information on the determinants of patient satisfaction. (Bible et al., 2018) All patients coming for anesthesia should have adequate perception regarding the care of patients in pre-operative anesthesia evaluation to improve standards of anesthesia care as well as to maximize satisfaction and benefits.

Statement of the Problem:-
A study to assess the perception of patients regarding information given in pre-operative anesthesia evaluation

Aim:
This study aims to determine patients' perception with the information provided in the pre-operative anesthetic evaluation 924

Objectives:-
The objective of the study is to assess the percentage of patient perception with the information provided in preoperative anesthesia evaluation

Study design
The researchers conducted a descriptive-analytical study in Saad Abu El-Ella Hospital in Khartoum and EL-MAK NIMR University Hospital in Sudan, from April 2016 to April 2019, to find the degree of patient's perception with pre-operative anesthesia information.

Study population sampling procedure
The current analytical study recruited about 300 participants, after calculation of the sample size by using the formula.
The study included all patients with minor or major operations, surgical and gynecology, and obstetric procedures coming requiring anesthesia during the study period. This study excluded participants with Age less than 15 or more than 85 years, unconscious patients for 24 hours after the operation, patients discharged before 24 hours, and the patient refused to participate in the study. The study selected participants by organized simple random technique

Description of Study Procedure
Anesthesia technologists who were not participating in pre-operative anesthesia evaluation, did a direct interview and filled a questionnaire. The study team used a 5-point psychometric (Likert scale) to rate the degree of patient perception. After obtaining consent, the researchers gave all the participants who were coming for pre-operative anesthesia evaluation a validated questionnaire after 24 hours of the surgery and requested to complete it, and provide their responses.

Data collection procedure:
All the questionnaires were anonymous and marked with a number. The study evaluated the participants' perception using a 5-point Likert scale, which indicated to the degrees of satisfaction and presented them in frequency tables and figures.

Statistical analysis:
Data was captured on Microsoft-Excel worksheets and analyzed after editing for completeness. Completed questionnaires were analyzed, and we excluded incomplete ones. The study used a descriptive statistical method to interpret data using frequency and percentage for categorical variables like gender. The research conducted a primary descriptive statistical analysis of 5-point Likert's items and calculated rate, mean, and standard deviation, as well as the percentage of satisfaction of the participant, for each item in the questionnaire. The study measured the responses with the 5-point Likert scale and rated them from (1)(2)(3)(4)(5). And they considered A p-value of < less than 0.05 to be significant. The study used the results to support quantitative and qualitative responses.

Results of the study:-
The study included a total of three hundred participants, and the ages ranged from   The study calculated the averages of patient perception with the information given to them in pre-operative anesthesia evaluation, and rated the significant findings according to Likert scale as follow: strongly agree 70 (23.3%), agree, 75 (25%), neutral 76(25.3%) disagree 43 (14.3%) strongly disagree 36 (12% ). {Figure 2} The study compared patient perception according to their ages and made a relationship between the age difference and information .the result showed P. value equal to 0.607. {Table 2 }

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The study stated a significant relationship between patient genders and perception with information, and the P. value was 0.00. {Table 3 }.
The study investigated levels of education versus patient perception with the information given in pre-operative anesthesia evaluation and revealed P.value is equal to 0.002. {Table 4 }.
The study analyzed the participants' physical status according to the American Society of the anesthesiologist and found a P-value of 0.002. {Table 5 }.

Discussion:-
In recent decades, hospitals and their components have faced increasing pressure to deliver their mission in a financially sustainable way to patients who have become intelligent consumers in the medical center. These new states have been challenging for many clinics, including the pre-operative anesthesia clinic.
This study analyzed the perception of patients with the information given to them by anesthesia providers in preoperative anesthesia evaluation and discussed the results and compared the most critical finding with other studies in the same area. Most of these studies supported the hypothesis. They referred to the objectives which assured by the low rate of patient satisfaction with information and communication during pre-operative anesthesia evaluation. However, in this recent study, the result found females were more satisfied regarding the perception ofinformation than males. The study confirmed that educated patients were less confident than illiterates. The study agreed that patients with ASA 4 were less satisfied than ASA1. All these findings arein harmony with a study conducted in Saudi Arabia, which also showed nearly the same in education level and classification of physical status (ASA) the study found female perception was significantly lower than male. Also, patients with ASA I-II considerably had lessawareness than ASA III patients. (Baroudi, Nofal and Ahmad, 2010 The study stressed that university-level educated patients were less aware than others. It showed similarity in finding in a survey conducted in Saudia Arabia. However, the study measured the variables after 24 hours of operation by a modified questionnaire filled by researchers, and in Saudi Arabia, they use a self-administered questionnaire. (Baroudi, Nofal and Ahmad, 2010) The patients' response to information dealt with in the pre-operative time and the requirement of perception is symmetric with many studies and agreed. They showed less understanding with information about the pre-operative anesthesia area. Participants said anesthesia providers gave insufficient Information-Sjoling's et al. (2015). In a recent study about improving the management of acute post-operative pain priorities for change, the finding agreed with the current research. In which they determined that giving patient information affected the perceptions of the patients and improved their satisfaction with pain management. (Meissner et al., 2015).
Another study showed that pre-operative nursing visits could decrease the level of pre-operative anxiety and postoperative complications in this patient population. Concluded that confirming the discussion of specific patient issues and education would reduce the stress and difficulties in post-operative, which in turn will improve patient satisfaction. Sadat et al. (2013). In most of the studies, they agreed on giving precise information in the preoperative period to satisfy what they expect and very sure to affects the total quality of care. (Chaichian, 2013). In the current study, patients who participated in the study showed their opinion and described the low levels of their perception withinformation. Only 48.3% agreed that information was given as they expect during their care process. Another study conducted in Greek patients has reported high satisfaction with perioperative anesthesia care. They seek the interaction between patients and anesthesiologists during all periods of study. Absence of shivering in regional anesthesia and adequate post-operative pain control in the ward were significant predictors and the overall patient satisfaction in anesthesia services rates in the range of 96.3%. (Kouki et al., 2012).
The variation could be becauseof different socio-demographic characteristics of the study design, the absence of standardization during the entry into the pre-operative system, as well as combined with an overall lack of ununified processes of patient care. Without intention contributes to communication insufficiency and patients' general comprehension of a lack of care coordination. (Young, 2017) The study concluded that measures should be taken to improve patient's information and reinforce the communication of patients with the staff of anesthesia in the pre-operative -anesthesia area.

Conclusion:-
In respect of the following results, considering the degree of average patient's perception with pre-operative anesthesia evaluation, the study observed a significantly shallow awareness. It is essential to revise the policies of health care organizations, increase motivations, as well as stress the preparation of the information booklets, etc., which will educate the patient. The study is suggesting advanced studies to discover factors affecting patients the perception in the pre-operative anesthesia evaluation clinics.