title: A multidisciplinary approach to improve preoperative understanding and reduce anxiety: a randomised study.
abstract: BACKGROUND
  Emotional factors may influence reception of information provided during informed consent leading to incomplete understanding and reduced satisfaction.
  
  
  OBJECTIVE
  This study was designed to test the hypothesis that a multidisciplinary approach could improve understanding of the information provided by the anaesthesiologist and in turn, reduce anxiety.
  
  
  METHODS
  A randomised controlled clinical trial.
  
  
  METHODS
  Veneto Oncology Institute, Italian comprehensive cancer centre. Recruitment from December 2008 to June 2010.
  
  
  METHODS
  Two hundred and fifty-one women requiring anaesthesia for breast cancer surgery.
  
  
  METHODS
  Women undergoing surgery for primary breast cancer were randomly assigned to either the structured anaesthesiology interview group (SAI) or the integrated multidisciplinary psycho-oncological approach (IPA). In the IPA arm, patients underwent an interview with the psycho-oncologist. Subsequently, and prior to preoperative anaesthesia evaluation, the psycho-oncologist informed the anaesthesiologist of the type of communicative strategy to adopt for each individual. In the SAI arm, patients received only the anaesthesiology interview.
  
  
  METHODS
  Anxiety as assessed by State-Trait Anxiety Inventory (STAI) questionnaire.
  
  
  RESULTS
  Two hundred and fifty-one patients were randomised and 234 analysed: 124 in the IPA arm and 110 in the SAI arm. For both groups, mean anxiety scores, according to the STAI questionnaire, were statistically lower after the anaesthesiology visit than at baseline, with a reduction of 6.5 points for the IPA arm [95% confidence interval (CI) 4.6 to 8.4, P < 0.0001] and 4.7 points for the SAI arm (95% CI 2.6 to 6.7, P < 0.0001). There were no significant differences between the two groups in the mean anxiety score before and after the interview. For highly anxious patients, the STAI score decreased significantly more in the IPA group (10.2 points, 95% CI 7.4 to 13.0) than in the SAI group (6.8 points, 95% CI 3.8 to 9.8), P = 0.024.The information provided during the anaesthesiology visit was correctly understood by more than 80% of patients and was similar in both groups.
  
  
  CONCLUSIONS
  In breast cancer surgical patients with high levels of preoperative anxiety, a multidisciplinary approach with psycho-oncological intervention proved to be useful at the preoperative anaesthesiology interview.
authors.affiliation: From the Anaesthesiology Unit (EG, BD, AAC, VM), Psycho-oncology Unit (IG, EC), and Clinical Trials and Biostatistics Unit (PDB, DK, GLDS), Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy *Elisa Granziera and Irene Guglieri contributed equally to this study.
authors.forename: Elisa
authors.initials: E
authors.lastname: Granziera
authors.forename: Irene
authors.initials: I
authors.lastname: Guglieri
authors.forename: Paola
authors.initials: P
authors.lastname: Del Bianco
authors.forename: Eleonora
authors.initials: E
authors.lastname: Capovilla
authors.forename: Barbara
authors.initials: B
authors.lastname: Dona'
authors.forename: Angelo Antonio
authors.initials: AA
authors.lastname: Ciccarese
authors.forename: Denise
authors.initials: D
authors.lastname: Kilmartin
authors.forename: Valentina
authors.initials: V
authors.lastname: Manfredi
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: De Salvo
mesh_terms: D000758:Anesthesia / Q000379:methods; D000776:Anesthesiology / Q000379:methods; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D001943:Breast Neoplasms / Q000601:surgery*; D002173:Cancer Care Facilities; D003142:Communication; D005260:Female; D006801:Humans; D007258:Informed Consent; D007558:Italy; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods; D011795:Surveys and Questionnaires