Patients' perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study

Khu, Kathleen Joy; Doglietto, Francesco; Radovanović, Ivan; Taleb, Faisal; Mendelsohn, Daniel; Zadeh, Gelareh; Bernstein, Mark

doi:10.3171/2009.6.jns09716

Cited by 99 publications

(130 citation statements)

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“…18 However a previous study by our group demonstrated low degrees of anxiety and high levels of satisfaction. 22 Our present study aims to acquire a better understanding regarding music and its role in helping to ameliorate surgically related stress and optimize overall hospital experience for patients undergoing awake craniotomy.…”

mentioning

confidence: 99%

Music is Beneficial for Awake Craniotomy Patients: A Qualitative Study

Jadavji-Mithani

Venkatraghavan

Bernstein

2015

Can. J. Neurol. Sci.

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Objectives: Patients undergoing awake craniotomy may experience high levels of stress. Minimizing anxiety benefits patients and surgeons. Music has many therapeutic effects in altering human mood and emotion. Tonality of music as conveyed by composition in major or minor keys can have an impact on patients' emotions and thoughts. Assessing the effects of listening to major and minor key musical pieces on patients undergoing awake craniotiomy could help in the design of interventions to alleviate anxiety, stress and tension. Methods: Twenty-nine patients who were undergoing awake craniotomy were recruited and randomly assigned into two groups: Group 1 subjects listened to major key music and Group 2 listened to minor key compositions. Subjects completed a demographics questionnaire, a pre-and post-operative Beck Anxiety Inventory (BAI) and a semi-structured open-ended interview. Results were analyzed using modified thematic analysis through open and axial coding. Results: Overall, patients enjoyed the music regardless of the key distinctions and stated they benefitted from listening to the music. No adverse reactions to the music were found. Subjects remarked that the music made them feel more at ease and less anxious before, during and after their procedure. Patients preferred either major key or minor key music but not a combination of both. Those who preferred major key pieces said it was on the basis of tonality while the individuals who selected minor key pieces stated that tempo of the music was the primary factor. Conclusion: Overall, listening to music selections was beneficial for the patients. Future work should further investigate the effects of audio interventions in awake surgery through narrative means.RÉSUMÉ: La musique est bénéfique chez les patients qui subissent une craniotomie en état vigile : une étude qualitative. Objectifs: Une craniotomie peut provoquer un stress important chez les patients et tant les patients que les chirurgiens bénéficient d'une réduction de l'anxiété. La musique a plusieurs effets thérapeutiques sur l'humeur et les émotions chez les humains. La tonalité de la musique d'oeuvres en mode majeur et d'oeuvres en mode mineur peut avoir un impact sur les émotions et les pensées des patients. Le but de l'étude était d'évaluer les effets sur les patients d'oeuvres musicales en mode majeur et d'oeuvres en mode mineur pendant la craniotomie en état vigile afin d'aider à élaborer des interventions destinées à soulager l'anxiété, le stress et la tension. Méthode: Nous avons recruté 29 patients qui subissaient une craniotomie en état vigile. Ils ont été randomisés en deux groupes : les patients du groupe 1 écoutaient de la musique en mode majeur et ceux du groupe 2 écoutaient de la musique en mode mineur. Les sujets ont complété un questionnaire démographique, l'inventaire d'anxiété de Beck avant et après la chirurgie et une entrevue semi-structurée à questions ouvertes. Les résultats ont été analysés au moyen d'une analyse thématique modifiée, par codage ouvert et codage a...

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confidence: 99%

Music is Beneficial for Awake Craniotomy Patients: A Qualitative Study

Jadavji-Mithani

Venkatraghavan

Bernstein

2015

Can. J. Neurol. Sci.

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“…In contrast to the previous research described, two recent studies, conducted in Canada (Khu et al 2009) …”

Section: Qualitative Studiesmentioning

confidence: 56%

An interpretative phenomenological analysis of the patient experience of awake craniotomy: Brain tumour diagnosis to discharge

Fletcher

Nair

Macniven

et al. 2012

British J Health Psychol

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Thesis AbstractIntroduction. This thesis explored patient experiences of awake craniotomy.Existing literature is scarce and dominated by quantitative methodologies. More recently two qualitative studies have provided a rich, but contrasting, understanding of the patients" experience of awake craniotomy.The methodological weaknesses of the existing literature are addressed, and the rationale for the study justified. Objectives.The aim of the study was to explore seven participants" experiences of awake craniotomy using interpretative phenomenological analysis.Methods. Single-site ethical approval was gained to conduct the study in one NHS Trust. All potential participants were approached who had undergone the awake craniotomy procedure at the NHS Trust. Semi-structured interviews were conducted with participants. Interviews were transcribed verbatim and analysed using an interpretative phenomenological analysis framework.Results. Analysis of transcripts yielded three superordinate themes: selfpreservation, operation environment and information. The superordinate themes were interpreted as interconnected with each other, as well as embedded in a core theme: relationship with the neurosurgeon. The three superordinate themes are presented and discussed within the journal article.The extended paper elaborates on two of these superordinate themes. References 93Appendices 107 Tables Table 1: Interview Schedule 6 Table 2: Participant Information 9 List of AbstractObject: Previous research exploring the patient experience of awake craniotomy has yielded inconsistent results. In the current study the authors aimed to explore the lived experience of having undergone an awake craniotomy in the United Kingdom.Methods: Seven participants took part in the study, which used a qualitative research methodology. Each participant was interviewed using a semi-structured interview schedule. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis.Results: Three superordinate themes: self-preservation, operation environment and information were identified. It was interpreted that each of these themes was embedded in a core theme: relationship with the neurosurgeon. Conclusions:The relationship with the neurosurgeon appears crucial to the patient experience of awake craniotomy: from brain tumour diagnosis to discharge. This knowledge requires consideration in clinical settings and could lead to improved delivery of care in the future.

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“…33,34 Patients who undergo awake surgery would presumably like to do so because they believe it will improve outcomes and minimize complications. 15 Undoubtedly, they would be surprised and dismayed to learn that factors never disclosed to them influenced their surgeon to recommend the procedure. Most patients trust their surgeon and follow the recommended course of action so the responsibility is the surgeon's to be open and fair with his/her recommendation.…”

Section: Resultsmentioning

confidence: 99%

“…29,30 Patients have reported that having brain surgery done as outpatients made their disease seem less serious, which contributed to emotional well-being and aided in the recovery process. 15 Although a strong argument can be made for performing awake craniotomy on tumors regardless of the proximity to eloquent cortex, as well as on an outpatient basis, to do so means some patients will form a part of the neurosurgeon's learning curve. In other words, they will be used as practice for the benefit of others.…”

Section: Surgical Innovationmentioning

confidence: 99%

“…Even though there are no randomized prospective studies demonstrating that awake craniotomy is superior to craniotomy under general anesthesia in terms of patient outcome, many different studies have determined it to be safe, well-tolerated and efficient. 1,2,4-7 The benefits of awake craniotomy include the avoidance of general anesthesia and its potential for complications, 15 as well as fewer intensive care admissions and shorter overall hospital stays. 1 In addition, it cuts operating times, and less frequently requires the use of a Foley catheter, endotracheal tube, and central venous or intra-arterial lines than does general anesthesia.…”

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confidence: 99%

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Ethical Challenges with Awake Craniotomy for Tumor

Kirsch

Bernstein

2012

Can. J. Neurol. Sci.

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78The frequency and indications for use of modern awake craniotomy are increasing. 1 The first "contemporary" application was for the treatment of epilepsy in the early 17th century. 2,3 It was followed by resection of tumors from eloquent brain regions, [1][2][3][4][5][6] and then to routine, nonselective tumor resection regardless of the involvement of eloquent cortex. 1,7 Faster resumption of normal activity by the patient and more efficient use of medical resources has led to its performance with less regard to tumor location, and even on an outpatient basis in some neurosurgeons' practices. 8-10 Awake brain surgery is also used for neuromodulation in the treatment of idiopathic Parkinsonism, essential tremor, dystonia and chronic pain, 11,12 and has been experimentally applied in a number of nonmovement disorders such as depression, obsessive compulsive disorder, Tourette's disorder, Alzheimer disease, chemical addiction and obesity. 12 We explore some of the factors that influence whether to recommend awake brain surgery to tumor ABSTRACT: Background: Awake brain surgery is useful for the treatment of a number of conditions such as epilepsy and brain tumor, as well as in functional neurosurgery. Several studies have been published regarding clinical results and outcomes of patients who have undergone awake craniotomy but few have dealt with related ethical issues. Objective: The authors undertake to explore broadly the ethical issues surrounding awake brain surgery for tumor resection to encourage further consideration and discussion. Methods: Based on a review of the literature related to awake craniotomy and in part from the personal experience of the senior author, we conducted an assessment of the ethical issues associated with awake brain tumor surgery. Results: The major ethical issues identified relate to: (1) lack of data; (2) utilization; (3) conflict of interest; (4) informed consent; (5) surgical innovation; and (6) surgical training. Conclusion: The authors respectfully suggest that the selection of patients for awake craniotomy needs to be monitored according to more consistent, objective standards in order to avoid conflicts of interest and potential harm to patients.RÉSUMÉ: Défis éthiques concernant la craniotomie en état vigile pour traiter une tumeur. Contexte : La chirurgie du cerveau en état de vigile est utile pour traiter certaines pathologies telles l'épilepsie et les tumeurs cérébrales ainsi qu'en neurochirurgie fonctionnelle. Plusieurs études ont été publiées sur les résultats cliniques et l'issue chez des patients qui ont subi une craniotomie en état vigile, mais peu d'études ont traité des aspects éthiques. Objectif : Les auteurs ont exploré d'une façon large les questions éthiques entourant la chirurgie en état vigile effectuée pour l'ablation de tumeurs dans le but de favoriser un examen plus approfondi du sujet et de susciter la discussion. Méthode : Nous avons procédé à une évaluation des questions éthiques associées à la chirurgie en état vigile pour l'ablation d'une tumeur c...

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Patients' perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study

Cited by 99 publications

References 6 publications

Music is Beneficial for Awake Craniotomy Patients: A Qualitative Study

Music is Beneficial for Awake Craniotomy Patients: A Qualitative Study

An interpretative phenomenological analysis of the patient experience of awake craniotomy: Brain tumour diagnosis to discharge

Ethical Challenges with Awake Craniotomy for Tumor

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