Patient engagement involves educating patients, giving them information, obtaining their informed consent and involving them in decision making with their healthcare team.
This improves their experience, outcomes and adherence to treatment.
Factors that influence patient engagement include, but are not limited to:
- demographic characteristics1-3
- access to convenient and responsive healthcare4
- culturally safe and appropriate healthcare4
- health literacy4
- self-efficacy1-3
- practical and emotional support4
- health information and education in accessible formats.5
Actively engage patients, families, carers and clinicians to collaboratively consider information and needs throughout the perioperative process. This includes the risks and benefits of the surgery or procedure as well as the desired outcomes.
Patient engagement varies along a spectrum. The extent of engagement can shift depending on the circumstances.
Increasing level of engagement and influence
Consumers lead the development of activities, products and services with appropriate advice and support
Consumers co-lead the development, design, implementation and evaluation of activities, products and services
Consumers are represented and can make recommendations and influence decisions
Consumers are invited to provide feedback about products and services developed
Consumers receive information about the group's activities (e.g. by being subscribed to the mailing list)
The spectrum of public participation. Adapted with permission: International Association for Public Participation.
Health literacy
Consider how well a patient and their family or carer understands health information, especially when communicating perioperative risks and engaging in shared decision making.
When caring for a patient, family or carer with low levels of health literacy:
- use a healthcare interpreter when needed6
- consider providing written instructions in multiple languages, e.g. top languages in the local health district, and/or in a format that includes pictures and words
- consider using an online real-time editor to enhance the design of written materials, ensuring they follow principles of readability and use patient-centred language7
- get guidance from the appropriate hospital/district multicultural or refugee health service, Aboriginal hospital liaison service or diversity health literacy committee.
Perioperative patient information
A booklet or checklist will help a patient, their family or carer to keep track of important information about their upcoming surgery or procedure. A perioperative patient information checklist could include the following:
- Admission time
- Fasting information
- What to bring to hospital
- Medication information
- Expected length of stay
- Discharge instructions
The surgeon or anaesthetist may also provide information or handouts relevant to the specific surgery or procedure.
Consent
Informed consent requires shared decision making between the healthcare team, the patient, and their family or carers. It is patient's decision to agree to the surgery or procedure, and the patient can give or withdraw consent at any time.
Consent must take place after the patient has:8
- received accurate and relevant information about the surgery or procedure, and other options
- adequate knowledge to consider the benefits and risks of the surgery or procedure
- considered what to do if there are any complications9
- collaboratively discussed their goals and wishes.
Further consent considerations are:
- if a patient is unable to give consent, obtain consent from an appointed guardian or a ‘person responsible’10
- an interpreter is essential for a patient who does not speak or read English.
- consent must be documented and submitted with the request for admission.11
- if a patient consents, consider the timing of surgery, including preoperative optimisation to enable best outcome.
If a patient decides not to have the surgery or procedure:
- offer them alternative clinical options, e.g. specialist and allied health referrals to improve functional status
- consider palliative and supportive care, if needed
- communicate the decision with the primary referrer. Provide a deterioration plan to manage any decline in health.11
Shared decision making
Shared decision making means a patient, their family, carers and healthcare professionals work together to decide on the appropriate healthcare based on the patient’s goals, preferences and the best available evidence on treatment options.
Shared decision making is part of the entire perioperative journey. This supports patient autonomy and patient-centred care.12
Resources
Consent
Consent to medical and healthcare treatment manual
Operational guidance and procedures to support compliance with NSW consent laws.
Source: NSW Health
Standard Procedures for Working with Health Care Interpreters (PD2017_044)
When and how to work with health care interpreters to support safe, effective and clear communication between health staff and patients,
their carers and families.
Source: NSW Health
Shared decision making
Consumer enablement guide: Shared decision making
A consumer resource on practising shared decision making, including tools.
Source: Agency for Clinical Innovation
Partnering with Consumers Standard
A standard for providing clear communication and involving patients in their own care.
Source: Australian Commission on Safety and Quality in Healthcare
Shared decision making
A range of resources and tools to help clinicians implement shared decision making.
Source: Australian Commission on Safety and Quality in Healthcare
Shared decision making, a short film
A short film describing how shared decision making could help plan for surgery.
Source: Peter MacCallum Cancer Centre
The SHARE Approach
A five-step process for shared decision making.
Source: Agency for Healthcare Research and Quality
Health literacy
Health literacy
Information on health literacy, how it affects safety and quality of care and where action can be taken.
Source: Australian Commission on Safety and Quality in Health Care
Health literacy framework: A guide to action
A framework to improve health literacy for patients, staff and health care facilities.
Source: NSW Clinical Excellence Commission
References
- Gaffney HJ, Hamiduzzaman M. Factors that influence older patients' participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature. PLoS One. 2022;17(6):e0269840. DOI: 10.1371/journal.pone.0269840
- Bonetti L, Tolotti A, Anderson G, et al. Nursing interventions to promote patient engagement in cancer care: A systematic review. Int J Nurs Stud. Sep 2022;133:104289. DOI: 10.1016/j.ijnurstu.2022.104289
- World Health Organization. Patient engagement: Technical series on safer primary care. Geneva, Switzerland: WHO; 2016 [cited 28 Mar 2024].
- Agency for Clinical Innovation. Working with consumers: A person-centred innovation strategy. NSW, Australia: ACI; Jul 2021 [cited 18 Jan 2024].
- Australian Commission on Safety and Quality in Health Care. Partnering with patients in their own care. Sydney, Australia: ACSQHC; 2019 [cited 18 Jan 2024].
- NSW Ministry of Health. Policy directive: Interpreters - Standard procedures for working with health care interpreters. NSW, Australia: NSW Ministry of Health; 19 Dec 2017 [cited 28 Mar 2024].
- Ayre J, Muscat D, Bonner C, et al. Sydney Health Literacy Lab (SHLL) Health Literacy Editor. Sydney, NSW: University of Sydney; 2021 [cited 28 Mar 2024].
- Australian Commission on Safety and Quality in Health Care. Informed consent. Sydney: ACSQHC; 2024 [cited 30 Apr 2024].
- Victorian Perioperative Consultative Council. Improving perioperative care before, during and after surgery: annual report 2020. Victoria, Australia: Safer Care Victoria; Mar 2021 [cited 28 Mar 2024].
- NSW Civil and Administrative Tribunal. Consent to medical or dental treatment. NSW, Australia: NCAT; 8 Sep 2022 [cited 28 Mar 2024].
- Australian and New Zealand College of Anaesthetists. PS26(A) Position statement on informed consent for anaesthesia or sedation 2021. Sydney, Australia: ANZCA; 2021 [cited 28 Mar 2024].
- Vogel A, Guinemer C, Fürstenau D. Patients' and healthcare professionals' perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: a scoping review. BMC Health Serv Res. Feb 24 2023;23(1):197. DOI: 10.1186/s12913-023-09120-4