• Emily Hladkowicz, David Yachnin, Laura Boland, Kumanan Wilson, Annette McKinnon, Kira Hawrysh, Terry Hawrysh, Cameron Bell, Katherine Atkinson, Carl van Walraven, Monica Taljaard, Kednapa Thavorn, Dawn Stacey, Homer Yang, Christopher Pysyk, Husein Moloo, Doug Manuel, David MacDonald, Luke T Lavallée, Sylvain Gagne, Alan J Forster, Gregory L Bryson, and Daniel I McIsaac.
• Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
• Can J Anaesth. 2020 Dec 1; 67 (12): 1749-1760.

PurposePatients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk communication tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care.MethodsWe conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application's materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability.ResultsWe included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (- 1.9%; 95% CI, - 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists.ConclusionExposure to a patient-facing, personalized risk communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery.Trial Registrationwww.clinicaltrials.gov (NCT03422133); registered 5 February 2018.

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