Understanding Patient Expectations of Lymphedema Surgery

Fahradyan, Artur, M.D.; El-Sabawi, Bassim, B.S.; Patel, Ketan M., M.D. Plastic and Reconstructive Surgery: June 2018 – Volume 141 – Issue 6 – p 1550–1557

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Understanding Patient Expectations of Lymphedema Surgery

Fahradyan, Artur, M.D.; El-Sabawi, Bassim, B.S.; Patel, Ketan M., M.D. Plastic and Reconstructive Surgery: June 2018 – Volume 141 – Issue 6 – p 1550–1557

Background: Patients with lymphedema refractory to medical treatment often have unrealistic expectations for lymphedema surgery. The purpose of this study was to assess patient expectations following lymphedema surgery.

Methods: Patients presenting to the clinic for initial evaluation for lymphedema surgery were offered to complete a survey designed to evaluate their expectations for limb appearance, limb function, and overall well-being following lymphedema surgery. The patients were instructed to score each item using a five-point scale for improvement. A mean expectation score was calculated, which was then used to estimate the effects of preoperative variables on patients expectations using multiple regression analysis.

Results: A total of 21 women and two men with a mean age of 60 years completed the survey. The upper limbs were affected in 10 patients and the lower limbs were affected in 13 patients. Physicians were the initial source of information about lymphedema surgery as a potential treatment option in 10 patients (43 percent), and a majority of the patients [n = 15 (65.2 percent)] thought that the physicians had fair or poor knowledge about lymphedema surgery. Significant or complete improvement was expected by 43.4 to 73.9 percent of patients. Patients’ level of education, the disease duration, and the initial source of information about lymphedema surgery had a statistically significant impact on patients’ expectations.

Conclusions: Early data suggest that most patients learn about lymphedema surgery from nonphysicians, with many expecting complete or significant improvement of lymphedema-associated symptoms with surgery. These findings emphasize the importance of addressing patient expectations and providing appropriate counselling before surgery.

Main findings

  • Patients expecting surgical intervention to provide complete resolution of their lymphedema may have poorer satisfaction with their postoperative outcome because of their expectations. Despite this, surgeons can optimize patient satisfaction by involving the patient in the preoperative consultation, actively exploring the patient’s expectations, and assessing and responding to the patient’s understanding of the discussion.
  • Small sample size of 23.
  • Significant or complete improvement was expected in all aspects of limb appearance, limb function, and overall well-being by 43.4 to 73.9 percent of patients. Improvement in limb appearance within 6 months after surgery was expected by 69.5 percent, in limb function by 60.8 percent, and in overall well-being by 60.7 percent of patients, whereas the rest of the patients expected to have improvement in limb appearance, limb function, and overall well-being in 6 months to 1 year and greater than 1 year after surgery.
  • The method of first learning about lymphedema surgery (p = 0.038) had a statistically significant impact on patients’ expectations for lymphedema surgery. The total mean expectation score was inversely related to the patient’s level of education, with scores decreasing by an average of 0.386 points (SE, 0.163; p = 0.045) with each unit of increase in the level of education. Patients who first learned about lymphedema surgery from non physicians had a higher expectation score by 1.213 points.
  • It has also been well demonstrated that patient satisfaction and health-related quality of life are directly associated with patients’ expectations.
  • More than half of the study population expected significant or complete improvement in limb appearance, limb function, and overall well-being. The majority of these patients expected the improvement to occur within 6 months after surgery. If not properly educated, these patients may be at risk of poorer satisfaction with the postoperative outcome and health-related quality of life.
  • To understand what can be done in setting the appropriate expectations, it is crucial to learn about the factors that impact patients’ expectations. This study suggests that patients’ level of education, disease duration, and the initial source of information about lymphedema surgery correlate with patients’ expectations.
  • Patients presenting later in their disease course likely had more severe disease and suffered longer, and thus had a stronger desire to have significant or complete improvement, which may have affected their expectations.
  • Referring them for surgical treatment earlier in their disease course may help to initiate the discussion about lymphedema surgery earlier and set more realistic expectations