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Study into the benefits of preparatory information prior to minor surgery in

primary care settings and its consequent effect on reducing

preoperative and peri-operative anxiety.

James. D. Whyman Submission date: 22.05.09 Word Count: 4,873

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Contents: Title Page………………………………………………………………………………1 Abstract……………………………………………………………………………...3,4 Introduction…………………………………………………...……………………..4-6 Literature Review……………………………………………………………………7,8 Objectives……………………………………………………………………………...9 Method…………………………………………………………………………..…9,10 Results…………………………………………………………………………….11-14 Discussion……………………………………………………………………...…15-18 Strengths and limitations of study………………………………………………...19,20 Implications for future practice………………………………………………………21 Appendix 1…………………………………………………………………………...22 Appendix 2…………………………………………………………………………...23 Appendix 3…………………………………………………………………………...24 Appendix 4………………………………………………………………………..25,26 Appendix 5………………………………………………………………………..27,28 References………………………………………………………………………...29,30

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Abstract: Objectives: To determine any significant link between patient anxiety and amount of

pre-operative information given with particular regard to gender and whether the

surgical unit is General Practitioner (GP) led or Surgeon led. This will involve the

identification of different anxieties relating to certain procedures. Design: This study

was a randomised controlled equivalency trial involving the distribution of

questionnaires to consenting adults undergoing minor surgical procedures. Setting:

Two surgical units, one surgeon/GP led (Surgery A) and one GP led unit (Surgery B)

in two neighbouring towns. Participants: Consenting patients over the age of 18

requiring elective minor surgery. Results: A total of 193 participants (96 surgery A:

53 males 43 females) (97 surgery B: 38 males 59 females) Surgery A: Most common

procedures performed were hand surgeries followed by skin procedures (39.5% and

20% respectively). The main anxieties for men were pain (33.3%), and success of

operation (31%).

Main anxieties for women were success of operation (48%) and pain (39%). Surgery

B: Most common procedures performed were skin operations (56.7%) followed by

joint injections (14.4%). Main anxieties for men were pain (57%), and success of

operation (31%). Main anxieties for women were the success of the operation (30%)

and anaesthetic (27%). Conclusions: The results show that there were higher levels of

satisfaction from patients undergoing minor surgical procedures in the surgeon led

unit. (100% satisfaction with the amount of preoperative information given) as

opposed to 84% from surgery B. This opinion was largely as a result of patients’

comments on the questionnaires regarding the information they had received

preoperatively and peri-operatively. (See appendix patients’ comments). Implications

for future practice: Minor surgical units could implement a basic patient satisfaction

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questionnaire so as to encourage better communication between the staff and the

patient therefore creating an informal patient-centred relationship. This proposed

survey can potentially identify and record any pre-operative anxieties and be easily

addressed at the time of the procedure allowing for better patient-centred care. This

implementation can be very useful for auditing purposes as well as patient

satisfaction.

Introduction:

Historically, minor surgery has been an important service offered by a general

practice. This was largely due to the implementation of the National Health Service

Plan (DoH 2002), which focused on patient choice of where they could go for

specialist clinics within their community. Since this time, General Practitioners (GP’s)

have been keen to promote minor surgery services to their patients as an alternative to

hospital admission. This could relieve the pressures on secondary care, their staff,

waiting times enabling instead, easier access, shorter waiting times and flexibility

(DoH 2006). Patients attending for minor surgery are often very anxious about the

procedure and educating the patient before surgery as to what to expect and how the

procedure is carried, out can reduce pain and aid relaxation postoperatively (Wilmore

and Kehlet 2001). This paper acknowledges this and supports the implementation of

preparatory assessment, a tool recommended by the Government (NICE 2003), which

is already being used in secondary (hospital) care.

The aim of this study was to determine the benefits of information given to patients

prior to minor surgery in primary care led units and its consequent effects on their

potential anxiety.

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Contributing factors, which may potentially influence anxiety, will be considered for

example gender and type of anxiety.

In addition by reading previous patient questionnaires from the surgeries illustrated,

underlying variables were identified and included in this study.

This in turn led to a more in-depth analysis of preoperative anxiety in patients, the

implications of which could be significant for improving patient centred care.

Distractions such as the provision of music during the procedure and the use of

educational videotapes prior to procedures will be briefly discussed.

The author’s study aims to examine these key principles with the intent of relating

them to general practice.

Patient surveys from two local medical practices within neighbouring towns were

selected. One practice has a dedicated surgical centre whose consultants are qualified

surgeons from secondary care acting in partnership with the GP (Surgery A), also a

qualified surgeon. The other practice has a small in-house minor surgical unit run by

GP’s experienced in minor operative procedures, (Surgery B). Both practices see

patients prior to the date of surgery, to inform, consent and document the procedure,

which is a compulsory requirement of their regulatory body (GMC 2004) , but no

formal pre-operative assessment is undertaken, as is encouraged in secondary care

(NICE 2003).

The results will illustrate areas of patient anxiety, for example, pain, recovery, time

off work and if there is a link between either practices. This may prove of interest in

establishing whether a practice with qualified surgeons is more effective at allaying

anxiety than a GP led minor surgical unit.

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A large study, the MiSTIC trial (George et al 2005) compared minor surgery in

primary and secondary care (hospitals) and concluded that patient satisfaction was

greater in primary care and therefore reduced patient anxiety. (See appendix 1).

However the same study suggested that while it was more cost effective to perform

minor surgery in hospitals, due to a more successful surgery (for example complete

cyst excision) this may not be a popular option as it would increase workload and

inconvenience patients.

Gilmartin (2004) suggested that nurses are well suited to assess patients pre-

operatively because they are very good at giving information.. Patients clearly felt

prepared and assessed adequately by nurses, although a minority felt their needs were

not addressed leaving them feeling anxious. This study was designed within

secondary care surgical units, but demonstrates that communication skills and

knowledge of procedures is essential, which is the case in the primary care setting.

Gilmartin and Wright (2007) explain that information given should be wholly patient-

centred to alleviate anxiety and that communication skills are therefore vital for

General Practitioners (GP’s) specialising in minor surgery to support the pre-

assessment process.

GP surgeries undertake regular audits to establish patient satisfaction regarding the

services available. This is a requirement through clinical governance (NICE 2008)

whereby NHS organisations are accountable for maintaining the provision of high

standards of services . This often involves the distribution of patient questionnaires.

The results of the questionnaires or surveys are essential for ongoing clinical practice,

thus changes can be made through auditing to ensure best practice and therefore

patient satisfaction.

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Literature review:

Nice Guidelines – CG3 – Preoperative tests. These government guidelines form the basis of patient consent before surgery. They address the importance ethically and legally of consent, and, in addition include the guideline that states that “patients should have access to sufficient information about risks, benefits and alternatives to be able to make an informed decision about whether to consent”. www.nice.org.uk/nicemedia/pdf/CG3NICEguidelineposter.pdf

Patient anxiety and modern elective surgery: a literature review. This report states that although there has been a significant rise in day-surgeries i.e. elective surgery, preoperative psychological care has remained fairly static. “A considerable number of patients are very anxious prior to elective surgery and little formal care is undertaken to address this major issue”. This study involved reviewing the key fears of patients undergoing elective surgery and identifying any interventions that primarily address said anxieties. Mitchell M 2003 Journal of clinical nursing – Volume 12, issue 6 p.806-815 A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial. This study’s aims were to collect data on the quality of the surgery undertaken alongside patient satisfaction, safety and cost in primary and secondary care. The results of this study showed that the safety of the patient is of paramount importance and that primary care is not safe as it is currently practised. The MiSTIC trial highlighted that hospital based minor surgery would be more cost effective but there is not the capacity to undertake the workload. Alongside this, it was established that secondary care minor surgery was unpopular with patients due to waiting times and that they preferred primary care. George S et al NHS National Library for Health 2005. Direct Access Minor Surgery service--patient satisfaction and effectiveness. D. Bandyopadhyay, B. Turnpenny, and E. P. Dewar. This study analysed patient satisfaction with direct access minor surgery services in secondary care centres i.e. hospitals. Direct access meant that no prior outpatient appointment was attended. The results showed that the service was favourable among patients and that 90% were satisfied with the preoperative information given. This study with regard to the MiSTIC trial conforms to the same conclusions, though the patient satisfaction level was surprisingly high given the allegedly unpopular service due to long waiting times. Ann R College of Surgery England. 2005 July; 87(4): 248–250. The effect of music on preoperative anxiety in day surgery Cooke M et al 2004 This study showed that the use of music in day surgery significantly reduces patient anxiety levels. The study also concluded that there was no clinical relationship between clinical variables such as gender or type of surgery.

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The nurse’s role in day surgery; a literature review. Gilmartin J, Wright K. This study showed that patient anxiety was significantly reduced by the use of music, story telling and distraction. In addition the deficits included poor preoperative information giving resulting in high anxiety. The conclusion was that adequate preparation and psychological support was necessary in obtaining high patient satisfaction levels. International Nursing Review. 2007 Jun; (5492):183-90 Day surgery: patient’s perceptions of a nurse-led preadmission clinic. Gilmartin J. This study concluded that a nurse-led clinic was effective, and “most patients felt they were adequately assessed and prepared for day surgery”. The results showed that there was a high level of patient satisfaction due to conveyance of comprehensive information and the opportunity to ask questions about the procedure. Clin Nurs. 2004 Feb;1392):243-50 The effect of detailed, video-assisted anaesthesia risk education on patient anxiety and the duration of the pre-anaesthetic interview: A randomised trial. This study focuses on educating patients in pre-anaesthetic clinics by showing informative videos regarding anaesthetics and risks. They concluded that patient anxiety remained static but led to better understanding of the procedure itself. Salzwedel C et al. 2008 Anaesthetic and analgesia Jan; 106 (1): 202-209 Angela Coulter and Jo Ellins Effectiveness of strategies for informing, educating, and involving patients. BMJ Jul 2007; 335: 24 - 27; doi:10.1136/bmj.39246.581169.80 Douglas W Wilmore and Henrik Kehlet Recent advances: Management of patients in fast track surgery. BMJ Feb 2001; 322: 473 - 476; doi:10.1136/bmj.322.7284.473 E Hunt Raleigh, M Lepczyk, C Rowley - Journal of Advanced Nursing, 1990 - Blackwell Synergy Significant others benefit from preoperative information. Shuldham - International Journal of Nursing Studies, 1999 - ncbi.nlm.nih.gov A review of the impact of pre-operative education on recovery from surgery. Krupat, E. Fancey, M and Cleary P.D.(2000) Information and its impact on satisfaction among surgical patients. Social Science & Medicine - Elsevier

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Objectives:

The main aim of this study was to discover any possible correlation between patient

anxiety and the amount of pre-operative information given. There are very few

published studies relating to this area although the author found there to be large

amounts of anecdotal evidence mainly applied to minor surgical units in general

practice. It is therefore also the author’s intention to clarify the relationship between

anxiety levels and information giving.

Method:

A patient questionnaire was designed to explore the anxieties people felt prior to their

minor surgery, their chief anxieties afterwards, and if there was a link between the

type of surgical procedure, age group and gender. Patient comments were encouraged.

In order to do this, the author sat in on pre-assessment clinics with a doctor and

observed the level of information given, how it was relayed and the patient’s

reactions. The doctor encouraged patients to ask questions so he could explain the

surgery in detail and at a level they could understand.

A survey was designed in conjunction with the structure of previous medical

questionnaires (see appendix 2) with particular reference to patient anxiety questions.

Using previous experience in observing minor surgical consultations, a list of

common procedures was devised so as to limit the results to purely quantitative

answers so as to avoid confusion during data analysis.

The initial pilot study was undertaken at the College of West Anglia to identify any

problems with the survey. It was decided that the ethnicity section of the survey was

redundant in the sense that it was of no significance in the results. The amended

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questionnaire was then distributed to the neighbouring GP practices. The author

consulted the doctors at each practice to gain permission and to ensure there were no

problems regarding the structure of the survey.

The questionnaires were given to each patient at the first clinic appointment and

collected either on the same day, or at the follow up assessment, usually after two

weeks. The results were obtained over a period of a several weeks and collated in a

database for analysis at a later date.

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Results:

Surgeon led surgical unit:

Sample (n = 96 patients)

Summary of results from a surgeon led unit

53

43

15

52

29

20

70

6

38

137

12

38

19

34

2418

9

0 0

96

0

20

40

60

80

100

120

male

female

16-35

36-60 61

+sk

in

toena

il

cryoth

erapy

injec

tions

hand

surge

ry

vase

ctomy

other

anae

sthes

ia

succ

ess o

f ope

ration

opera

tion

pain

work co

mmitmen

ts

family

commitm

ents

other

too m

uch i

nfo

not e

noug

h info

just ri

ght in

fo

Variables

num

ber o

f pat

ient

s

Chart to show most common anxieties in women prior to minor surgery in surgery A

43

5

21

4

17

12

15

0

5

10

15

20

25

30

35

40

45

50

Anxiety

num

ber o

f pat

ient

s

Series1 43 5 21 4 17 12 15

Females anaesthesia success of operation operation pain work commitments family commitments

12

Chart to show most common anxieties in men in Surgery A (surgeon led)

54

18

12

17

47

15

0

10

20

30

40

50

60

Anxieties

Num

ber o

f pat

ient

s

Series1 54 18 12 17 4 7 15

Males Pain Work Success of operation Family Anaesthetic Operation itself

Variable No. Patients Percentage of Patients (%) Male 53 55 Female 43 45 16-35 15 16 36-60 52 54 61+ 29 30 Skin 20 21 Toenail 7 7 Cryotherapy 0 0 Injections 6 6 Hand surgery 38 40 Vasectomy 13 14 Other 7 7 Anaesthesia 12 13 Success of operation 38 40 Operation itself 19 20 Pain 34 35 Work commitments 24 25 Family commitments 18 19 Other 9 9 Too much information 0 0 Not enough information 0 0 Just right information 96 100

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GP led surgical unit:

Sample (n = 97 patients)

Sumary of results from questionnaires from GP led surgical unit

38

59

29

47

14

55

7

14

0 0

9

2630

21

35

12

3

12

2

10

82

0

10

20

30

40

50

60

70

80

90

male

female

16-35

36-60 61

+sk

in

toena

il

injec

tions

hand

surge

ry

vase

ctomy

other

anae

sthes

ia

succ

ess o

f ope

ration

opera

tion

pain

work co

mmitmen

ts

family

commitm

ents

other

too m

uch i

nfo

not e

noug

h info

just ri

ght in

fo

Variable

No.

Pat

ient

s

Chart to show most common anxieties in men in surgery B (GP led)

38

1012

11

22

5

1

0

5

10

15

20

25

30

35

40

Anxieties

Num

ber o

f pat

ient

s

Series1 38 10 12 11 22 5 1

men anaesthesia success of operation operation pain work commitments family commitments

14

Chart to show main anxieties of women in surgery B (GP led)

59

1618

1013

7

2

0

10

20

30

40

50

60

70

Anxieties

Num

ber o

f pat

ient

s

Series1 59 16 18 10 13 7 2

Females anaesthesia success of operation operation pain work commitments family commitments

Variable No. Patients Percentage of Patients (%) Male 38 39 Female 59 61 16-35 29 30 36-60 47 49 61+ 14 14 Skin 55 57 Toenail 7 7 Injections 14 14 Hand surgery 0 0 Vasectomy 0 0 Other 9 9 Anaesthesia 26 27 Success of operation 30 31 Operation itself 21 22 Pain 35 36 Work commitments 12 12 Family commitments 3 3 Other 12 12 Too much information 2 2 Not enough information 10 10 Just right information 82 85

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Discussion:

The response rate from Surgery A (Surgeon led) was less than that of Surgery B. This

was most likely due to the fact that patients were asked to return their completed

questionnaires at their follow up appointments and many forgot to do so. The

response rate was calculated to be 80%. Having distributed 120 questionnaires and a

return of 96. (Surgery A). The response rate of Surgery B was approximately 98% as

questionnaires were completed on the day of the procedure.

The findings suggest that there were higher levels of satisfaction from patients

undergoing minor surgical procedures in the surgeon led unit. (100% satisfaction with

the amount of preoperative information given) as opposed to 84% from surgery B.

This opinion was largely as a result of patients’ comments on the questionnaires

regarding the information they had received preoperatively and peri-operatively. (See

appendix patients' comments).

Surgery A

The most common procedures performed were hand surgeries including carpal tunnel

decompression and trigger finger release followed by skin procedures including cyst

excision and removal of naevi. (39.5% and 20% respectively).

The main anxieties for men were pain (33.3%), and success of operation (31%).

The main anxieties for women were success of operation (48%) and pain (39%).

Surgery B

The most common procedures performed were skin operations including excisions,

cryotherapy (56.7%) followed by joint injections (14.4%).

The main anxieties for men were pain (57%), and success of operation (31%).

The main anxieties for women were the success of the operation (30%) and

anaesthetic (27%).

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From observing minor surgery in both areas and from patient’s comments, the author

concluded that the surroundings were an important factor for example comfort, music

and the reassuring professional attitude from the staff. Musical distraction is clearly

an important factor to reduce anxiety as suggested by Augustin and Hains 1996 and

Gilmartin and Wright 2007 who noted that music alleviated some anxiety particularly

if personal choice of music was considered. This is evident in the surgeon led unit

where nurses ask patients what their preference of music is. Surgery B provided radio

for patients to listen to in the waiting room but not in the theatre itself.

An older study by Augustin and Hains (1996) indicated that watching television prior

to and during operative procedures had a significant impact on the reduction of patient

anxiety. This was supported by a later study (Salzwedel 2008), which suggested the

use of educational videos representing surgery (in particular cataracts) was of benefit.

This could be implemented into modern minor surgical practice to ensure low anxiety

levels as a form of distraction therapy. Patients could view programmes of their

choice, although this may also prove too distracting for the surgeon.

Government guidelines recommend thorough pre-assessment and that as much

information should be given as possible, for example medication, past health history,

risks, benefits and alternatives to surgery enabling the patient to make an informed

decision about consenting for surgery. (DoH 2002). But what do patients want?

Oshodi (2007) discusses that surgery can be physically and psychologically stressful

and that pre-operative education can lessen pain post-operatively. From the results

obtained, patients from both practices have a clearly significant level of anxiety

towards pain, both during the operation and afterwards. Shuldham (1999) concludes

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that the use of pre-operative education has a beneficial effect on patient anxiety both

peri-operatively and post-operatively. Anxieties relating to pain can be potentially

resolved with a written information leaflet on analgesia prior to the surgery to reduce

pain levels and what medication would be of benefit afterwards. This is a fairly

common practice in some surgeries but should be considered in all minor surgery

units. With regard to anaesthesia related anxiety, more pre-operative information can

be given on the effects of local anaesthetic and what to expect in the hours after

surgery. It was noted that both men and women were concerned about work

commitments; Medical Certificates could be issued to allow recovery time before

returning to work.

Risk assessment is obviously important in pre-op assessment clinic but overall

patients liked the friendliness, careful explanation, information and the opportunity to

ask questions. Coulter’s study (2005) demonstrated that good interpersonal care that

is, good communications skills and practitioners with excellent clinical knowledge

have a profound effect on reducing patient anxiety. People want to be involved in

decisions around their care and continuity of their care; her article is based on a large

study by the Health Commission (2005), which implied that patients were generally

very positive about their primary care services. Although Coulter’s article applied to

all aspects of primary care, it can also be valuable in the minor surgery setting,

because people want an approachable friendly doctor who is able to communicate

well (Little et al 2005).

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Good communication skills from a doctor are vital for allaying anxiety in any

situation. (Silverman, Kurtz et al 2005) discuss the necessity for this because without

these essential skills, “all knowledge and intellectual efforts can easily be wasted”.

The author noted during observing doctors in both practices that although there was a

limited time spent with each patient, there was a clear understanding of the procedure

given and information around consent. The survey reflected this by the positive

comments from patients; the doctor helped them to feel comfortable and less nervous.

Patients need to know if the procedure will be painful, what sort of anaesthetic they

will be given, if there will be bleeding, how to care for the dressing if it leaks through,

and who to contact should there be a problem. Patients also seemed to like having the

appointment times for follow up care given there and then.

The results of this study agreed with those from the MiSTIC trial by George et al

(2008), in that patients within primary care were more concerned about success of the

operation or satisfaction with the wound and pain. In addition, according to George et

al, patients were more satisfied in primary care settings due to convenience, comfort

and privacy.

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Strengths and limitations of the study:

The pilot study identified any weaknesses in survey structure, for example, a large

section of the initial questionnaire included ethnicity which was irrelevant as the study

focused primarily on gender, type of surgery and nature of anxiety. Previous surveys

within the practices helped in restructuring the author’s questionnaire to make it easier

to read and analyse.

Time constraints were an issue prior to analysis of the results due to questionnaires at

surgery A being returned at follow-up appointments one to two weeks later. This was

not a problem with surgery B as the questionnaires were returned the same day.

With regard to sample size, the number of participants was 193. This could be seen to

be too small a sample and not reflect the general population, although other studies

(George et al 2008) had a sample size of 568, this had similar results.

There have been certain limitations with this study mostly involving data analysis due

to the initial questionnaire design. Retrospectively, a numerical scoring system

implemented into the questionnaire might have enabled a larger range of statistical

testing. For example a Chi Squared Test to measure significance between observed

values and expected values.

The particular method of analysis (i.e. histograms) was chosen as they can be read and

understood easily and require no prior mathematical or statistical knowledge to

interpret them.

The author was able to form a list of the most common surgical procedures due to

being able to sit in on surgical consultations with both practices and liasing with the

doctors and staff concerned. This was valuable as it formed the basis for the

questionnaire.

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The excellent feedback and comments from replies to questionnaires were obtained

allowing for a more thorough understanding of individual anxieties. In addition,

good relationships with the doctors and nurses involved in minor surgery enabled the

author to distribute the questionnaire easily and efficiently.

Pre-operative assessment and information giving is pivotal in promoting patient

satisfaction. Mitchell (1996) recognised that patients are individuals and prefer to be

given a choice regarding the information they require.

His study implied that levels of information could be developed according to their

level of understanding and needs. This information can be broken down to encompass

all areas that patients are likely to encounter. For example, pre-operative information,

peri-operative information (details of the operation itself while it is being performed),

and post-operative information. Mitchell also suggests there should be a choice of

accuracy regarding information, because some patients may require in depth

information, whilst others may prefer simpler terminology.

On observation at surgery A, it is apparent that these different levels of accurate

information are portrayed to the patients. For example, for those undergoing carpal

tunnel decompression, the surgeon draws the incision on the wrist and explains the

basic anatomy and what he is going to do. Patients appear to be in favour of this as is

illustrated in the feedback comments.

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Implications for future practice:

The implementation of written patient information, which covers all aspects of fears,

expectations, wound care and healing times should be common practice in all minor

surgery units when patients attend their first pre-assessment appointment. This would

encourage better communication between the patient and doctor because it promotes a

good, informal relationship that is patient centred. Effective communication skills are

vitally important in maintaining a good relationship with the patient undergoing a

minor operation. The ability to field questions from a nervous patient and understand

their perspective can be essential in alleviating anxiety. Being able to establish a good

rapport with a patient can be seen as highly professional yet comforting as observed in

both surgeries during the pre-operative assessment.

The proposed information would identify and record anxieties mentioned and have

these addressed at the time of the operation. A patient questionnaire returned at the

follow-up appointment would also prove a useful tool for auditing purposes as well as

ongoing patient satisfaction.

Annual audits and surveys remain an important part of general practice because it can

help to identify any problems, for example standards of care and treatment,

accessibility to services and general satisfaction. This is a good way to involve

patients as it gives feedback, both positive and negative, and the results can

potentially benefit those who require these services.

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Appendix 1

A prospective randomised comparison of minor surgery in primary and secondary

care. The MiSTIC trial.

S George et al Health Technology Assessment 2008.

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Appendix 2

Previous patient satisfaction questionnaire from one of the practices in the study.

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Appendix 3

Patients Comments

Surgery A

• Doctor talked me through operation so I did not get nervous

• Very anxious but Dr and nurses made me feel better and calm. Very good.

• Couldn’t wish for better service from NHS.

• Well looked after making me feel welcome.

• Very easy going, very professional.

• Dr put me at ease, explained everything.

• Worried about being able to walk and work afterwards, hoped that anaesthetic

would be enough and that pain would go quickly.

• Good information from Dr made me feel at ease.

Surgery B

• Very nervous about having procedure, fear of unknown.

• Very professional service, Dr made me feel at ease.

• Was very anxious but staff explained everything.

• Very happy about service provided.

• Unhappy with cosmetic scarring.

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Appendix 4 The author’s questionnaire (after alterations).

Pre-­‐operative  and  post  operative  survey  

1. Are  you:  

Male   �  

Female   �  

 

2. What  age  range  do  you  belong  to?  

16-­‐25  �   26-­‐35  �   36-­‐45  �   46-­‐60  �   61+  �  

 

 

3. Have  you  ever  undergone  a  minor  operation?  (Minor  meaning  local  anaesthetic)  and  performed  at  an  NHS  practice.  

Yes  

�  

No  

�  

4. If  yes,  what  was  the  procedure(s)?  

Cyst  excision  (having  a  cyst  removed)   �  

Removal  of  naevi  (moles)   �  

Toenail  operations/procedures   �  

Removal  of  skin  tumours   �  

Cryotherapy  (freezing  treatment)   �  

Injections  for  tennis  elbow/joints   �  

Hand  surgery  including  Carpal  Tunnel  and  Trigger  Finger   �  

Vasectomy   �  

Other  

……………………………………………………………………………………………………………………………………………………  

�  

                     

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Questionnaire  Continued:  

 

5.  What  were  your  main  anxieties  about  the  procedure?  

Anaesthesia   �  

Success  of  the  operation   �  

The  operation  itself   �  

Pain   �  

Work  commitments   �  

Family  commitments   �  

Other  

……………………………………………………………………………………………………………………………………………………  

�  

 

5. How  do  you  feel  about  the  information  given  to  you  prior  to  and  after  your  minor  operation?  

Too  much  

�  

Not  enough  

�  

Just  right  

�  

 

6. Any  other  comments?  

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..  

Thank you for completing this questionnaire, all information will remain confidential and anonymous. Please do not write your name on this questionnaire.

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References:

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