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Nova Scotia researcher leads study into anesthesia, patients' priorities

One of the eight new operating rooms at Dartmouth General Hospital. - Eric Wynne
An operating room is seen during a tour of a new wing of Dartmouth General Hospital. - Eric Wynne / File

As someone who’s undergone 14 surgeries, Linda Wilhelm knows her stuff when it comes to recovering from these procedures.

The Hampton, N.B., woman had her first operation related to rheumatoid arthritis in 1998, when she had a total hip replacement. Since then, she’s had surgical work done on every joint in her body except one ankle and one elbow.

Her last operation was in 2016 when she had another total hip replacement.

Linda Wilhelm, who has undergone 14 operations since 1998 as a result of rheumatoid arthritis, says the effects of anesthesia can be more difficult for recovery than the operation itself. - Contributed
Linda Wilhelm, who has undergone 14 operations since 1998 as a result of rheumatoid arthritis, says the effects of anesthesia can be more difficult for recovery than the operation itself. - Contributed

Not surprisingly, Wilhelm, who was diagnosed with rheumatoid arthritis in 1983, has learned a lot about being her own patient advocate. For example, she’s found that the side-effects of anesthesia are more of a problem for her than the actual surgery.

“I need good pain control after surgery, I can’t have nurses rationing out medication, they need to let me decide when I need it,” she said in a recent interview.

Wilhelm also became very nauseated after surgery — it took her about six operations to straighten that out with medical teams.

“(I told them) you need to give me the good drug for nausea because it was the expensive drug and they didn’t like to give it to patients very much.

“So once I figured out I had a voice in all this — they actually listen to patients (now). Before they kind of figured they knew everything — by the time I got to (operation) No. 14, they said, well you know what you need and they left instructions for the nurses and let me kind of set the pace.”

As president of the Canadian Arthritis Patient Alliance, Wilhelm tries to pass on what she’s learned about navigating the system.

She took part in a study last year conducted by the Canadian Anesthesia Research Priority Setting Partnership that brought patients and clinicians together to identify areas that future anesthesia research in Canada should address.

The study focused on issues like how anesthesiologists can improve pain control after surgery and the impact of reducing opioids during anesthesia on patient outcomes and opioid dependence after surgery.

“If you actually direct the research questions appropriately, it then improves the patient’s experience,” said Dr. Dolores Mckeen, chief of women’s and obstetric anesthesia at the IWK Health Centre, and the leader of the study.

“A lot of different agendas drive what questions are actually being asked,” Mckeen said, such as the academic community or the medical industry. That can delay the implementation of necessary changes by years.

“But if you can actually find out what’s important for the patient, what’s their perspective ... that allows us to ask the right questions and it actually allows us to readily translate that information quickly.”

Most Canadians will experience at least one surgery in their lifetime. In 2015-16, there were roughly 1.47 million inpatient surgical procedures conducted in Canadian hospitals. That’s a big poof of knowledge and experience that can be better utilized, Mckeen said.

For the study, she assembled a steering committee in 2017 made up of patients and caregivers, anesthesiologists, nurses and other health-care providers.

The committee came up with an initial “conglomeration” of hundreds of priorities for anesthesia research, Mckeen said.

These suggestions were sent out in a national survey to 254 anesthesia patients. The resulting submissions eventually pared the list down to 22 research priorities, which were discussed at the workshop Wilhlem attended in May 2019.

The workshop participants narrowed the list even further to 10 priorities. At the top of the list was the need for researchers to focus on what factors could best improve patient outcomes and satisfaction before, during and after receiving anesthesia for surgery.

“It’s kind of odd because you know I’ve spent 20-odd years of my career training, learning to be an expert in anesthesia but what patientcentred care would say is, I’m an expert in my condition,” Mckeen said.

“So I think physicians and anesthesiologists are very much changing their approach from a physician-centred patriarchal I know what’s best to listening to what the patient feels is best.”

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1 being least likely, and 10 being most likely

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