A pilot study by researchers at Washington University School of Medicine in St. Louis examines the way patients seek out information prior to having surgery, and how that information impacts patients’ health care decisions.
The research, published in the SAGES journal Surgical Endoscopy, emphasizes the importance of preoperative patient education and shared decision-making between patients and medical professionals.
The study also offers insights into the impact of media exposure on patients’ views of surgical procedures.
Mesh in the Media
Jeffrey Blatnik, MD, Assistant Professor in the Section of Minimally Invasive Surgery, is an expert in surgical repair of abdominal wall hernias. A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. According to the National Institutes of Health, hernias are common, and can be caused by a combination of muscle weakness and straining, such as heavy lifting. Hernias can be treated through open or laparoscopic surgery. In many cases, a medical device—called surgical mesh—is used to provide additional support to the weakened tissue.
“The main reason we use surgical mesh for hernia repair is to reduce the risk for hernia recurrence,” Blatnik says. “For most hernias, mesh has been shown to be an important part of the repair.”
Surgical mesh is a useful tool in many procedures, but Blatnik noticed that some of his patients had preconceived notions about mesh prior to their clinical visit. Blatnik and a team of researchers in the Department of Surgery examined how those patients’ views of surgical mesh impacted their decisions regarding hernia repair surgery.
Patients presenting for evaluation of hernia repair with mesh were given surveys before and after their initial surgical consult. The surveys evaluated internet use, mesh research completed, the impact on patient opinions and decisions, and the impact of research on the patient-physician interaction.
The study found that 93% of patients had heard of surgical mesh through the media.
“Surgical mesh is a relevant topic currently in the forefront of the media, and it exposes patients to targeted messages predominantly from legal sources,” the researchers write.
Over half of the patients in this study were motivated by their media exposure to conduct further research on mesh prior to making a decision about surgery.
“Undeniably, there have been some issues with certain meshes throughout the years, and some patients have had negative outcomes as a result,” Blatnik says.
The Food and Drug Administration (FDA) reports that complications related to hernia repair with surgical mesh are mostly associated with recalled mesh products no longer on the market.
“Given the incredibly large number of patients that have had mesh used, this makes it a big target for law firms, which are the primary drivers of negative advertising,” Blatnik explains. “Ultimately, the vast majority of patients who have surgical mesh placed do very well and don’t have any complications related to their mesh.”
Patients with negative views of mesh generally had more media exposure. After their surgical consult, these patients felt confident in their knowledge of risks associated with mesh, but reported having the least perceived knowledge of the benefits of the medical device.
By contrast, patients who had prior surgery without complication had the most positive attitude toward mesh, and were less likely to do further research than those with complications or no prior surgery.
Empowering Patients through Education
The study, which was a collaboration between Blatnik, medical student Matthew P. Miller and research resident Saeed Arefanian, emphasizes the importance of educating patients prior to surgery. Some patients had assumptions—whether positive or negative—about surgical mesh that could impact their health care decisions. Conducting internet-based self-education through search engines can be helpful, but depends on the patient’s e-literacy and the quality of information they find. To help guide patients to balanced, non-commercial information, the researchers provided a link to the FDA website titled Hernia Surgical Mesh. Among the patients who viewed this page, most found it beneficial. Blatnik hopes that sharing more useful, unbiased resources with patients might help empower them to make informed decisions regarding their health.
In order for patients and physicians to engage in shared decision-making, it is important that they communicate their concerns and questions openly. Blatnik encourages patients to do their research, and to then talk to their surgeon about that research. This kind of communication allows the surgeon to better educate their patient and prepare them for surgery.
“This study shows a need for us as surgeon educators and leaders to provide unbiased information for patients to help them make an informed decision and feel comfortable with their choices at the time of surgery,” Blatnik asserts. “For each patient, the goal of the operation may be slightly different—to prevent recurrence for some, to reduce risk of infection for others. At Washington University School of Medicine and Barnes-Jewish Hospital, each patient is evaluated on a case by case basis to determine if mesh is appropriate. We hope to provide support for patients to make the best decision for them.”