Comparison of Patient Satisfaction in Post-operative Breast Surgery Patients Having Physical Clinic and Tele Clinic Follow up: A Randomized Controlled Trial

Study Overview
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Brief Summary
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The Purpose of this study is to measure patient satisfaction in standard Post- operative Breast Outpatient clinics versus teleclinics. Post operative breast surgery patients who volunteer for this study will be randomized into either of the two groups Standard outpatient physical clinics or Telephone clinic and their satisfaction will be measured afterwards using a validated standardized questionnaire by a assessor who will be blind to the type of follow up. This will be a single blinded randomized controlled trial.

Detailed Description
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The incidence of Breast Cancer is increasing in Pakistan and worldwide. In 2018, 2.1 million new cases were reported, with 627,000 deaths. Pakistan has the highest incidence of breast cancer among Asian countries: one in nine women is at risk of being diagnosed with breast cancer during their lifetime. According to the International Agency of Research on Cancer 2018 report, 34,066 new cases of breast cancer had been reported in Pakistani women. The Outpatient department Clinics are a standard part of routine follow-up for post-operative patients. Conventional Outpatient clinics incur hefty financial costs on patients living in distant areas. Access to the telephone is increasing worldwide as technology advances and becomes more accessible to patients. Its use in healthcare settings is inevitable. In post-operative setting, remote consultation is feasible as the usual discussion is about the histopathology report of the procedure performed along with referrals for Adjuvant treatment. Nonetheless, there are some hesitations with this type of consultation. For instance, a visit to a physical clinic may help in early detection of potential complications which may be missed in remote consultation. Similarly, patients may not be satisfied with remote consultation alone. Tele clinics, which became popular in the wake of Coronavirus disease pandemic, have been instrumental in improving healthcare delivery in Breast Surgery patients and this has been demonstrated by multiple studies but the data regarding patient satisfaction is not available in our population and needs to be studied. Study Design: Randomized Controlled Trial Setting: Department of surgical oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore. Enrollment: Patients will be enrolled pre-operatively, in the holding bay prior to the surgery. Sample Size: A sample size of 184 is calculated using a confidence level of 0.95 and power of 0.80. The calculation is based on hypothesis that in our population the satisfaction percentage of patients having follow up in tele clinic will be 75% whereas the satisfaction percentage of patients having follow up in physical clinic will be 90%. Including a 10 % refusal rate/dropout rate, a total of 202 patients will be randomized in to two groups of 101 each. Study Duration: Four months after the initiation of enrollment Follow up Schedule: 2 weeks after surgery, either in physical clinic or tele clinic Randomization: Pre-operative randomization will be carried out and patients will be allocated to either of the groups by selecting the name of the group to which patient has been randomized from a sealed envelope. The type of randomization would be 'Computerized block randomization'. Research Randomizer software, a free to use software will be used for this. Blinding: Assessor determining the patient satisfaction will be blinded to the type of follow up. This will be ensured by restricting the information available to accessor to only the name and contact number of the patient. The assessor will therefore have no access to the electronic health record of the patient and will not be able to determine the type of follow up of the patient.

Official Title
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Comparison of Patient Satisfaction in Post-operative Breast Surgery Patients Having Physical Clinic and Tele Clinic Follow up: A Randomized Controlled Trial (PSPVT Trial)

Conditions
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Satisfaction, Patient, Satisfaction

Intervention / Treatment
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* Other: Teleclinic
* Other: Physical Clinic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of Breast Cancer. Written informed consent for participation in the trial. Exclusion Criteria: Stage IV Breast Cancer. Chronic Pain. Breast Surgery with reconstruction.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Pre-operative randomization will be carried out and patients will be allocated to either of the two groups this will be done by 'Computerized block randomization'.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional out patient clinic<br>The volunteers of the study randomized into this group will be given traditional outpatient clinic follow up post surgery. | Other: Physical Clinic<br>* Patients will have to travel to come physically to hospital to meet the operating surgeon.<br>* Other names: Standard Clinic;|
| Active Comparator: Teleclinic<br>The Volunteer of the study randomized into this group will be given teleclinic appointment for follow up post surgery. | Other: Teleclinic<br>* Instead of visiting surgeon after travelling from far flung areas for a post surgery follow up appointment, the follow up visit will be done using telephone.<br>* Other names: Remote Clinic;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Satisfaction | Patient satisfaction will be measured using Patient satisfaction questionnaire Short Form (PSQ-18). The short-form instrument, the PSQ-18, contains 18 items tapping each of the seven dimensions of satisfaction with medical care: general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctor, and accessibility and convenience. PSQ-18 is a free to use validated tool developed by RAND Corporation. | 3 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post operative complications | These will be recorded as per Clavien Dindo Classification (CDC) Grade I Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions Allowed therapeutic regimens are: drugs as antiemetic, antipyretics, analgesics, diuretics and Electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside. Grade II Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included. Grade III Requiring surgical, endoscopic or radiological intervention Grade IIIa Intervention not under general anesthesia Grade IIIb Intervention under general anesthesia Grade IV Life-threatening complications (including CNS complications) * requiring IC/ICU-management Grade IVa Single organ dysfunction (including dialysis) Grade IVb Multi-organ Dysfunction Grade V Death of a patient | 6 weeks | 
| Number of Emergency assessment room visits prior to follow up in Physical or Tele Clinic | If a patient visits Emergency assessment room prior to follow up appointment it will be recorded as it can affect the patient satisfaction. | 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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patient satisfaction, teleclinic, physical clinic, outpatient clinic, breast surgery, virtual clinics, randomized controlled trial, RCT, PSPVT Trial