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Contents Preface: Patient Perspectives in Pulmonary Surgery ix Alessandro Brunelli A 30-Year Perspective on Psychosocial Issues in Lung Cancer: How Lung Cancer Came Out of the Closet449 Talia Weiss, Mark Weinberger, Arielle M. Schwerd, and Jimmie Holland Psychological responses to lung cancer have changed over the past 30 years as perceptions of the disease have changed. Previously seen as a fatal diagnosis, it is now regarded as a cancer whose treatment is increasingly effective as the science of the disease advances. The stigma of smoking is diminishing as more is learned about genetic factors and as more nonsmokers are diagnosed. Support groups are now widely available. The increasing social support and greater knowledge of lung cancer provide a more supportive environment in which patients cope with lung cancer today compared with 30 years ago. Quality of Life in Pulmonary Surgery: Choosing, Using, and Developing Assessment Tools 457 D. Fitzsimmons, S. Wheelwright, and C.D. Johnson There is mounting recognition that, to aid surgical decision making, treatment effi- cacy needs to be measured in a variety of ways, with health-related quality of life now widely regarded as an important outcome in pulmonary surgical populations. The aim of this review is to provide a comprehensive overview of the key issues to consider if an investigator wishes to incorporate health-related quality of life assess- ment into trials and studies of pulmonary surgery, drawing on recent studies of lung cancer surgery as an example. Changes in Quality of Life After Pulmonary Resection 471 Alessandro Brunelli, Cecilia Pompili, and Michael Koller This article assesses the impact of pulmonary resection on quality of life by means of a systematic quantitative review of the available literature. Perioperative changes in quality of life scales were measured by the Cohen’s effect size method (mean change of the variable divided by its baseline standard deviation). After lobectomy, most quality-of-life scales differed slightly from preoperative values but tended to re- cover from the first evaluation time point up to 12 months after surgery. After pneu- monectomy, most scales showed a stable or declining trend from the first evaluation up to 12 months after surgery. Minimally Invasive Lung Surgery and Postoperative Quality of Life 487 John R. Handy Jr Quality of life (QOL) after medical interventions is paramount to the patient consid- ering treatment recommendations. To understand QOL in thoracic surgery patients, one must examine the outcomes patients prioritize (preferences) from successful surgical therapy, overall functional status of thoracic surgery patients, the literature addressing QOL after thoracic surgery (TS) and the possible benefit of minimally Patient Perspectives in Pulmonary Surgery

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Patient Perspectives in Pulmonary Surgery

Contents

Preface: Patient Perspectives in Pulmonary Surgery ix

Alessandro Brunelli

A 30-Year Perspective on Psychosocial Issues in Lung Cancer: How Lung Cancer“Came Out of the Closet” 449

Talia Weiss, Mark Weinberger, Arielle M. Schwerd, and Jimmie Holland

Psychological responses to lung cancer have changed over the past 30 years asperceptions of the disease have changed. Previously seen as a fatal diagnosis, itis now regarded as a cancer whose treatment is increasingly effective as the scienceof the disease advances. The stigma of smoking is diminishing as more is learnedabout genetic factors and as more nonsmokers are diagnosed. Support groupsare now widely available. The increasing social support and greater knowledge oflung cancer provide a more supportive environment in which patients cope withlung cancer today compared with 30 years ago.

Quality of Life in Pulmonary Surgery: Choosing, Using, and DevelopingAssessment Tools 457

D. Fitzsimmons, S. Wheelwright, and C.D. Johnson

There is mounting recognition that, to aid surgical decision making, treatment effi-cacy needs to be measured in a variety of ways, with health-related quality of lifenow widely regarded as an important outcome in pulmonary surgical populations.The aim of this review is to provide a comprehensive overview of the key issues toconsider if an investigator wishes to incorporate health-related quality of life assess-ment into trials and studies of pulmonary surgery, drawing on recent studies of lungcancer surgery as an example.

Changes in Quality of Life After Pulmonary Resection 471

Alessandro Brunelli, Cecilia Pompili, and Michael Koller

This article assesses the impact of pulmonary resection on quality of life by means ofa systematic quantitative review of the available literature. Perioperative changes inquality of life scales were measured by the Cohen’s effect size method (meanchange of the variable divided by its baseline standard deviation). After lobectomy,most quality-of-life scales differed slightly from preoperative values but tended to re-cover from the first evaluation time point up to 12 months after surgery. After pneu-monectomy, most scales showed a stable or declining trend from the first evaluationup to 12 months after surgery.

Minimally Invasive Lung Surgery and Postoperative Quality of Life 487

John R. Handy Jr

Quality of life (QOL) after medical interventions is paramount to the patient consid-ering treatment recommendations. To understand QOL in thoracic surgery patients,one must examine the outcomes patients prioritize (preferences) from successfulsurgical therapy, overall functional status of thoracic surgery patients, the literatureaddressing QOL after thoracic surgery (TS) and the possible benefit of minimally

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invasive TS, and, finally, future directions of TS postoperative QOL research. Theprimary focus of this article is lung cancer surgery with mention of other thoracicdisease such as empyema, pneumothorax, or emphysema, as well.

Quality of Life in the High-Risk Candidate for Lung Resection 497

Sabha Ganai and Mark K. Ferguson

Examination of the preferences of patients with lung cancer suggests that the idealtherapy may not be based on standard outcome measures such as survival, butshould also consider the morbidity, adverse effects, and convenience of the treat-ment. Functional outcomes after lung resection have particular importance in guid-ing decision making in high-risk operative candidates. In this article, quality-of-lifemeasures are reviewed in the context of guiding choices between operative andnonoperative therapies in a shared decision-making model for high-risk candidatesfor lung resection.

Surviving the Intensive Care: Residual Physical, Cognitive, and Emotional Dysfunction 509

Christina Jones

Patients recovering from critical illness may suffer from physical, psychological, andcognitive problems that have a negative impact on their health-related quality of life.To ensure that patients return as close as possible to their previous physical andmental health, their rehabilitation needs should be assessed and an appropriate pro-gram started. Both early mobilization and physical rehabilitation while the patient isstill in the intensive care unit and manualized rehabilitation after discharge are ben-eficial. It is important to assess the rehabilitation needs of patients and target phys-iotherapy and counseling resources at those patients with the greatest need.

Psychosocial Issues Facing Lung Transplant Candidates, Recipients and Family Caregivers 517

Emily M. Rosenberger, Mary Amanda Dew, Andrea F. DiMartini, Annette J. DeVito Dabbs,and Roger D. Yusen

Although lung transplantation is an accepted treatment for many individuals withsevere lung disease, transplant candidates and recipients experience a range ofpsychosocial stressors that begin at the initiation of the transplant evaluation andcontinue throughout patients’ wait for donor lungs, their perioperative recovery,and their long-term adjustment to posttransplant life. Transplant programs shouldstrive to incorporate evidence-based interventions that aim to improve physicalfunctioning, psychological distress, global quality of life, and medical adherenceas well as to integrate symptom management and palliative care strategies through-out the pre- and posttransplantation course.

The Patient-Surgeon Relationship in the Cyber Era: Communication and Information 531

J. Herman Blake, Mary Kay Schwemmer, and Robert M. Sade

From Laennec’s invention of the stethoscope in 1816 to the recently introducedSapien transcatheter aortic valve replacement, the increasing complexity of healthcare technology has altered the relationship between patients and physicians, usu-ally for the better. Telemedicine, the provision of medical services through electronicmedia, has dramatically changed how the patient and physician interact and howmedical care is delivered. Many studies of physicians’ perceptions of electroniccommunication with patients have documented recognition of benefits as well as

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a consistent chorus of concerns about confidentiality, increased workload, inappro-priate use, and medicolegal issues.

Patients’ Perspective in the Surgical Decision-Making Process 539

Eric Lim

Barriers can arise if surgeons are unable to effectively convey information on bene-fits and risks or are unwilling to offer management choices based on patients’ pref-erences. Facilitating shared decision making, allowing patients to carefully think andconsider the alternatives, and empowering them to share in the decision-makingprocess improve patient satisfaction and treatment adherence and represent thehallmark of an excellent clinician.

Patient Safety in the Surgical Setting 545

M. Blair Marshall and Dominic Emerson

Patient safety has been the subject of surgical investigation for the past century. Aspecific focus on safety and medical errors has incited public attention, governmentoversight, and research funding. Traditional efforts have been focused on the indi-vidual responsible for the “mistake,” while current procedure focuses on a systemsapproach. A critical analysis of medical errors, their frequency and cause, and out-comes associated with their occurrence has allowed the identification of system-based issues and the implementation of corrective changes to improve thesesystems. Constant vigilance examining errors and how they occur will allow identi-fication of strategies to reduce errors.

Patients’ Satisfaction: Customer Relationship Management as a New Opportunityfor Quality Improvement in Thoracic Surgery 551

Gaetano Rocco and Alessandro Brunelli

Clinical and nonclinical indicators of performance are meant to provide the surgeonwith tools to identify weaknesses to be improved. The World Health Organization’sPerformance Evaluation Systems represent a multidimensional approach to qualitymeasurement based on several categories made of different indicators. Indicatorsfor patient satisfaction may include overall perceived quality, accessibility, human-ization and patient involvement, communication, and trust in health care providers.Patient satisfaction is included among nonclinical indicators of performance inthoracic surgery and is increasingly recognized as one of the outcome measuresfor delivered quality of care.

Index 557