PATIENT SATISFACTION WITH ANESTHESIA CARE AMONG OPEN

CHOLECYSTECTOMY PATIENTS IN A TERTIARY HOSPITAL IN THE

PHILIPPINES

A Research Proposal

Presented to the

Southern Philippines Medical Center

Department of Anesthesiology

And

Cluster Ethics Review Committee

CHRISTINE ALEXIS S. DINOPOL, MD

MARIA CECILIA J. LOMBOY, MD

Authors

JOANNE A. REMEDIOS, MD, DPBA

Mentor

February 2023

TABLE OF CONTENTS
ACKNOWLEDGEMENTS
 CHAPTER 1

INTRODUCTION

I. TOPIC BACKGROUND

Patient satisfaction refers to the degree of fulfillment of a patient's anticipation and

expectations of services provided. It is the individual’s subjective judgment of the balance

between expectation and perceptions of what was received. It is a complex concept related to

several factors such as the individual’s values, social and cultural upbringing, emotional factors,

past experiences and future expectations1.

Historically, the perception of anesthesia care has always been poor. During the late

1980’s and early 1990’s movement in quality assurance in health care began to gather

momentum. One of its major aspects is the quality of patients’ experience in surgical and

anesthesia care. In 1996, an editorial on patient satisfaction revealed the emerging need to

evaluate satisfaction of patients with anesthesia care. Hence, anesthesiologists were compelled to

come up with a reliable assessment tool for this cause2.

Nowadays, it has become one of the most important indicators for assessing quality of

medical and surgical care. It has also become a crucial subjective measure of health quality

which contributes to evaluation of the structure, process and outcome of services, potentially

leading to improvements in health care.

According to the American Productivity Quality Center, a satisfied customer tells another

five people regarding their positive experiences on services availed while an unsatisfied
customer tells another nine to twenty people of the poor services rendered. Patient satisfaction in

anesthesia is a complex concept related to a number of factors. It can be influenced by the

patient’s emotional, social, and cultural background, past experiences and future expectations3.

This topic has been investigated in other countries. In a hospital in Northwestern

Ethiopia, 74% of their patients were satisfied in their anesthetic care, with pain during induction

greatly affecting their responses.4 In Eritrea, a study that included two hospitals revealed a score

of 68% in patients’ satisfaction in anesthetic care with less fear and concern scoring high in their

survey and information provision as the area needing most improvement. 1 While a multicenter

survey of patient satisfaction and experience with anesthesia in Saudi Arabia showed an overall

satisfaction level of 56.5%, with nearly half of the patients dissatisfied with their anesthetic care.

Nausea, vomiting and pain control were among the top reasons for dissatisfaction.2

However, in our local setting, we have not found any published study which explored the

level of patient satisfaction and the factors affecting it in terms of anesthetic services. The

investigators would like to fill this gap in knowledge to help improve anesthesia care.

In the United states, about 1.2 million cholecystectomies are done annually and it is one

of the most common procedures. Before the early 1990s, an open technique which involves a

right subcostal (Kocher) incision or upper midline incision to remove the gallbladder was the

standard. Post operatively, patients usually have a 2 to 6 days stay in the hospital. With the

advent of technology, the standard has changed to laparoscopic cholecystectomy 5. In our

institution however, Open cholecystectomy is still one of the most common surgeries performed.

It can be done under a variety of anesthetic techniques, such as general anesthesia (GA),

combined GA-neuraxial or GA-peripheral nerve block, or even pure neuraxial anesthesia.

Therefore, with this type of surgery, the investigators will be able to evaluate patient satisfaction

with different anesthetic techniques.

RESEARCH QUESTION

What are the perioperative anesthetic factors that affect the level of satisfaction among

patients for elective open cholecystectomy in Southern Philippines Medical Center (SPMC)?

II. SIGNIFICANCE OF THE STUDY

This study would like to measure the level of satisfaction in perioperative anesthetic care

among patients of Southern Philippines Medical Center presenting for elective open

cholecystectomy.

Specifically, the following will benefit from the results of this study:

1. Patients: The results of this study will help improve anesthetic care during

their hospital stay.

2. SPMC Department of Anesthesiology: The Department will not only be

able to identify which in the course of a patient’s perioperative stay needs

to be addressed, but will also be able to highlight the perioperative factors

greatly affecting patient satisfaction. This will help to formulate an

upgraded standard of care for all patients who will undergo an elective

procedure.

3. Hospital: Knowing the level of patient satisfaction and the factors

affecting it, in relation to the institution’s delivery of anesthetic services,

will help improve its goal in providing excellent quality service for all

patients encompassing diverse groups of religion, race, or status.

 4. Future research: This may serve as a baseline for future investigations in

other medical and surgical fields, and may improve or enhance their

methodology to obtain essential data for the improvement of their

respective services to their patients.

III. OBJECTIVES OF THE STUDY

A. General Objective

To evaluate patient satisfaction of open cholecystectomy patients in SPMC in

terms of perioperative anesthetic services

B. Specific Objectives:

1. Identify the sociodemographic and clinical profile of the participants in terms of:

a. Sex

b. Age

c. Educational status

d. Marital status

e. Anesthetic technique used

f. ASA classification

g. Duration of surgery

2. Determine the level of satisfaction of participants according to:

a. Trust and atmosphere

b. Fear

c. Discomfort
 d. Treatment by personnel

e. Information and waiting

3. Determine the associated factors to the level of satisfaction according to:

a. Sex

b. Age

c. Educational status

d. Marital status

e. Anesthetic technique

f. ASA status

g. Surgical duration

VI. DEFINITION OF TERMS

Anesthesia: A medical treatment using drugs called anesthetics that prevents patients from

feeling pain during medical procedures.

ASA I- a normal healthy patient

ASA II- a patient with mild systemic disease

ASA III- a patient with severe systemic disease

ASA IV- a patient with severe systemic disease that is a constant threat to life

ASA V- a moribund patient who is not expected to survive without the operation

ASA VI- a declared brain-dead patient whose organs are being removed for donor

purposes
ASA status: The American Society of Anesthesiologists (ASA) physical status classification

system developed to assess and communicate a patient’s pre-anesthesia medical co-morbidities.

Open Cholecystectomy: An open technique of gallbladder removal, usually involving a right

subcostal or upper midline incision

Perioperative Period: This period covers the time the anesthesia provider provided his/her

anesthetic service during pre-operative evaluation, intra-operative management, and

post-operative period up to 48 hours.

 CHAPTER 2

REVIEW OF RELATED LITERATURE

I. PATIENT SATISFACTION

Patient satisfaction is a subjective and complex concept. It refers to how patients perceive

services delivered by providers as satisfactory based on their personal requirements and

expectations.6 It is also determined by the balance of the provided care and the patient’s

expectations of that care. This is a core component of patient-centered care by satisfying their

needs at the time, which helps in reaching the goal of taking care of patients’ somatic, mental,

and spiritual health. If the patient experiences discrepancy, dissatisfaction arises.1 This is an

important aspect of healthcare since this can determine patient’s behavior towards adherence to

treatment, attending to consistent follow-up check-up, and healthcare resource consumption.6

Patient satisfaction also impacts the health of healthcare personnel and organization. A

satisfied patient can also motivate healthcare providers to provide the best possible care. On the

other hand, a dissatisfied patient may harm a healthcare organization through non-compliance to

therapy, or worse, never returning to the facility. Therefore, measurement of this parameter is an

important aspect of quality assurance.6

Physical, emotional, mental, social, and cultural factors are involved in the level of

patient satisfaction in anesthetic services. Different studies show that age, educational

attainment, marital status, expectations, information shared by the anesthesiologist, anesthesia

duration, perioperative complications, pain scores, and postoperative contact and visits greatly

impact satisfaction.6,7,8
 II. ANESTHESIA SERVICES

The young practice of anesthesiology has advanced greatly nowadays. 6

Anesthesia services are given to different types of patients, whether surgical or not, or outpatient

or inpatient, if required, to provide the best care and pain-free experience as possible. The

anesthesia service starts with a preoperative visit wherein the anesthesiologist, who is a physician

trained to administer anesthesia, does a focused history taking and physical examination to assess

the risk and develop plans for anesthesia delivery. This is also the time that the provider builds

rapport with the patient and explains the procedure, anesthesia plan, benefits, and risks.9

Different types of anesthetic techniques have evolved over the years. General anesthesia,

regional anesthesia, and monitored anesthesia care are specifically planned for the patient and the

type of procedure. Anesthesiologists, aside from providing anesthesia, are responsible for

monitoring, maintaining, and restoring homeostasis, diagnosing sources of pain, and doing

resuscitative measures during a surgery or procedure. They also direct the operation of the

operating rooms, ambulatory surgery clinics, and post-anesthesia care units.10

Postoperatively, all patients who received anesthesia care are monitored and

complications managed accordingly in a postanesthesia care unit (PACU) or its equivalent, e.g.

surgical intensive care unit (SICU). This ensures that a patient meets criteria for discharge to

home, a ward or intensive care unit. The anesthetic drugs given can remain in the body for 24

hours after administration.11 The patient may continue to be sleepy and judgement and reflexes

may take time to return to normal. This may last up to 24 hours. 12 In certain procedures,

especially those with complications such as pain, anesthesiologists are expected to follow these

patients postoperatively to assess and help in patient relief. 13

 The field of Anesthesiology has also branched out to different specialties to cater to the

demands that are unique in these patient populations, namely, neuroanesthesia, obstetric

anesthesia, cardiac anesthesia, thoracic anesthesia, pediatric anesthesia, pain medicine, critical

care anesthesia, regional anesthesia, transplant anesthesia, among others. This field is continually

evolving to meet the special requirements of different patients to manage these satisfactorily.12

III. FACTORS AFFECTING ANESTHESIA PATIENTS’ SATISFACTION

Patient satisfaction with anesthesia care has traditionally been a desired goal and a

determinant of care quality. However, assessing patient satisfaction of anesthesia care is

complex. Historically, this outcome is understudied, probably due to the lack of standard

measure. To date, there are still limited validated tools that measure this construct. Developing

such tools requires identifying factors affecting patient satisfaction13.

Collective evidence shows that patient satisfaction is higher with 1) providing

information (anesthesia providers explaining risks, benefits, alternative anesthesia options and

answering questions before anesthesia care), 2) involving patients in decision making, and 3)

continuity of care (e.g. postoperative visit). On the other hand, predictors of decreased patient

satisfaction include preoperative fear and anxiety, long perioperative waiting time, ASA class 1

or 2, experiencing awareness under anesthesia, nausea and vomiting, pain, postoperative

complications, type of surgery, and longer duration of surgery14.

Among the non-modifiable factors are gender, marital status, and education. While other

modifiable factors affecting patient satisfaction are interaction issues (confidence, interpersonal
skills, respect, staff-patient relationship, and trust), concern or kindness of caregiver, and

attention provided by anesthesia provider. Miscellaneous issues include duration of anesthetic,

emergence experience, feeling safe, importance of reassurance, memory of postoperative

instructions, nursing care in the PACU, past experiences, premedication and privacy13.

A multicenter study by Capuzzo, et. Al (2007) in Italy, examined patient satisfaction with

anesthesia care through a 10-item questionnaire with three domains namely: physical, emotional,

and relational. This study also examined the relationship of anesthesia staff members’ burnout

level using the Maslach Burnout Inventory, to patient satisfaction with anesthesia care. Results

revealed no relationship was found between staff burnout and level of patient satisfaction15.

In terms of postoperative recovery, a multicenter mixed cohort observational study by

Royse, et. al (2012), examined the impact of recovery on patient satisfaction at three days

following anesthesia and surgery. Using the Postoperative Quality of Recovery Scale (PQRS),

the study objectively measured recovery in five domains: physiological, nociceptive, emotive,

activities of daily living and cognitive. Furthermore, they assessed the patient’s overall

perspective as the sixth domain of recovery. Surprisingly, results showed that only the

nociceptive domain (pain and nausea) influenced satisfaction16.

IV. HEIDEL-BERG PERI-ANESTHETIC QUESTIONNAIRE

The Heidelberg Peri-anaesthetic Questionnaire is a psychometrically designed

questionnaire constructed and validated by fifty nine health care professionals. It consists of 38

questions about five identified themes: trust and atmosphere; fear; discomfort; treatment by

personnel; and information and waiting. These items were determined from data on literature

review on the subject matter and semi-structured interviews with patient focus groups and one-
to-one interviews with relatives and healthcare professionals. Cognitive survey and standard

pretest were then instituted.

This questionnaire has undergone validation with a wide spectrum of patients (1398

patients) at three different hospitals.The psychometric design protocol was followed rigorously

to achieve content validity. Furthermore, external validity was confirmed by correlations

between scores and the visual analogue scale (VAS) as well as the Spielberger Stat-Trait Anxiety

Inventory (STAI) and the Amsterdam Pre-operative Anxiety and Information Scale (APAIS). It

provides important information about patients’ perception of anesthesia care. It is easy to apply

in the clinical setting and has been proven to function as a cross-sectional instrument17.

In an integrative review by Hawkins et al of nine studies on patient satisfaction with

anesthesia, the Heildelberg perianesthetic questionnaire are among the studies with high

methodological rigor. Methodological rigor coding was accomplished by comparing factors,

such as sample size, study design and congruence with the study’s purpose (particularly design

and study purpose). Furthermore, only the Heidelberg perianesthetic questionnaire encompasses

patients who underwent combined general and regional anesthesia, while the rest of the studies

included patients undergoing general anesthesia only or regional anesthesia only 13. For the

purpose of our study, the Heidelberg perianesthetic questionnaire will be utilized as a tool for

evaluation since subjects of this study will be undergoing combined general and regional

anesthesia.
 CHAPTER 3

METHODOLOGY

I. Research Design

This is a prospective cross-sectional study where satisfaction is measured post

operatively, and sociodemographic and clinical profile will be assessed as a significantly

important factor for satisfaction of patients using chart review. In this study, the principal

investigators will conduct a face to face interview utilizing a validated questionnaire on

postoperative patients who will have elective open cholecystectomy at the Southern Philippines

Medical Center in a six month period.

II. Setting

The study will be conducted in the surgical wards of the Southern Philippines Medical

Center, a tertiary referral hospital.

III. Participants

The study will include all patients who meet the following criteria:

a. Inclusion Criteria:

● Patients for elective open cholecystectomy

● ages 18-60 years old

● who will give their consent for the study

b. Exclusion Criteria

● Patients without consent

 ● Those with neurocognitive dysfunction or other limitations who are unable

to participate in a face to face interview

● Those with concurrent conditions directly affecting measurement of

satisfaction (ASA 4 and above)

● Those who do not understand English, Filipino or Visayan language

IV. Sampling Procedures

This study will employ purposive sampling where only those who satisfied the inclusion

and exclusion criteria will form part of the research.

V. Interventions and Comparisons

In this study, no intervention will be done and thus no comparisons will be done.

VI. Data Gathering

Phase I. Approval of the Department and the Ethics Committee

This research proposal will be submitted by the principal investigators to the SPMC

Department of Anesthesia Research Committee for approval to conduct the study. After its

approval, this will be submitted to the SPMC Ethics Committee, the research can now conduct

recruitment of patients. Face to face interviews using a validated questionnaire will be used for

data collection. The questionnaire will be adapted from the Heidelberg Peri-Anesthetic

Questionnaire, a valid and reliable perioperative patient satisfaction assessment tool used in

previous studies on patient satisfaction with anesthesia care. It was obtained from a purchased

journal (Schiff, et. al, 2008). The questionnaire will then be translated to Filipino and Cebuano
and will be pretested on a sample population. The questionnaire has 38 questions with five

themes namely trust and atmosphere, fear, discomfort, treatment by personnel and information

and waiting, which will be assessed using a four point likert scale.

Phase II. Implementation and Data Gathering

Approval from the Ethics committee, Department of Anesthesiology and Department of

Surgery will be secured. Data will be collected by the principal investigators. All patients

satisfying the inclusion criteria will be included until the computed sample size will be reached.

The principal investigators will visit the patient postoperatively in the surgical wards and will

verbally explain the intentions of the study, instructions on data gathering and will secure

consent. Once consent is secured, the interview will be conducted and responses will be

recorded. Questions or confusions that may arise will also be answered.

Other data needed, such as details of sociodemographic and clinical profile will be

collected through chart review. After completeness of data is checked, it will be recorded and

analyzed using appropriate statistical tools. The principal investigators (PI) are not involved in

the perioperative anesthetic care of the patients.

a. Independent Variable:

The independent variables will be sociodemographic data (age, sex, marital status and

educational status), and clinical profile (types of anesthesia, and ASA classification, surgical

duration). Furthermore, factors affecting satisfaction such as waiting time, information given,

fear or anxiety before the procedure, emergence experience, post-operative nausea and vomiting

and treatment of personnel.

 b. Dependent Variables

The dependent variable of this study will be the level of patient satisfaction, which will

be recorded as a four-point Likert scale: 0 (strongly dissatisfied), 1 (dissatisfied), 2 (satisfied), 3

(strongly satisfied). A score of one or less will be classified as dissatisfied while a score of more

than one will be classified as satisfied.

VII. Sample Size Computation

Sample size computation for this descriptive study was done in Epi Info version 7.1.4.0

with the following assumptions: (1) the total population size of patients who underwent elective

open cholecystectomy in a six month period at our institution is 50 (2) the outcome, satisfaction

occurs to 74% of patients(1); (3) the desired precision is 5%. In a computation for the rate of

having the outcome among patients who underwent elective open cholecystectomy carried out at

<5% level of significance, a sample size of 43 patients is needed.

VIII. Data Handling and Analysis

The sociodemographic and clinical profile of patients will be analyzed in terms of

frequency and percent for categorical data and mean and standard deviation for continuous data.

The clinical outcomes will also be measured in terms of frequency and percent. For the level of

satisfaction, mean and standard deviation will be used.

To determine the factors associated with the satisfaction of patients, a Binary Logistic

Regression will be used for the study. Binary logistic regression analysis will determine the

strength of relationship between the variables to the satisfaction or dissatisfaction of patients.

IX. Ethical Considerations

Since data collection will be done during the post-operative period, ethical considerations

such as effects of anesthetics are considered, thus, to eliminate this, the following

checklist of functionality should be satisfied prior to conducting the data collection

Satisfied Not Satisfied

More than 24 hours post operation

Last sedative given more than 8 hours

Last opioid given more than 8 hours

Adequate pain control (VAS <4/10)

Feeding resumed

a. Ethics Review

Prior to conducting the study, approval from the Cluster Ethics Research Committee

(CERC) of Southern Philippines Medical Center (SPMC) will be secured by the primary

investigators or research assistant.

b. Informed Consent: Form

Participants of the study will be asked to fill up and sign on a written consent form prior

to conducting the interview. In cases wherein participants are not able to read or write,

the informed consent will be read out loud to the participants and consent will be secured

via thumb mark.

c. Informed Consent: Signatory

The written consent form will be signed by the participant of the study. If a signature is

unobtainable from the patient, a thumb mark will be obtained.

d. Informed Consent: Witness

A watcher of the patient, of legal age, whose signature is affixed on the consent form

would be considered the witness of the informed consent.

e. Informed Consent: Proxy Consent

Proxy consent will not be allowed.

f. Informed Consent: Process

Prior to giving consent, the principal investigators will check if criteria of ethical

considerations are all satisfied. Once the checklist is satisfied, the intentions of the study

and its significance will be explained to ensure that the participants understand and

voluntarily give consent. Questions and clarifications will also be answered.

g. Informed Consent: Timing and Venue

The informed consent will be taken at bedside in the surgical wards prior to conducting

the interview.

h. Disclosure of the Study Objectives, Risks, Benefits and Procedures

Through a short orientation, the participants will be informed as to the objectives

of the interview on patient satisfaction with anesthesia care; its purpose ( an evaluation

tool to improve on the delivery of the services); its beneficiaries (Department of

Anesthesiology, the hospital administration, and patients of SPMC); its expectations (full

participation in the interview); it risks (no direct harm on the participants).

i. Remuneration, Reimbursement and Other Benefits

There will be no remuneration or reimbursement and no direct benefits will be given to

the participants. Benefits of participation includes contribution to the body of knowledge

on perioperative anesthesia care and to the hospital’s surgical operations.

j. Confidentiality

All data collected will be handled with utmost confidentiality. Identities of each

participant will not be disclosed at any time. Only the principal investigators of the study

has the actual contact information of the patients. No pictures of the participants will be

taken. The data that will be obtained during the study will be under the Department of

Anesthesiology, Southern Philippines Medical Center. Personal information will not be

included during data analysis. All filled up questionnaires will be paper shredded upon

conclusion of the study.

k. Investigator’s Responsibility

There are no anticipated adverse events in the study. All data collected will be handled by

the principal investigators or statistician only.

l. Specimen Handling

There will be no specimens taken from the participants of the study.

m. Voluntariness
Participation in the study is voluntary. Each patient has the right to consent or refuse

participation.

n. Alternative Options

The interview will be conducted face to face. There are no other alternatives for the

interview.

o. Privacy

Only the participant’s initials will be recorded, all other personal information and

responses to the interview will be secured and kept private.

p. Information on Study Results

At the end of the study, the results will be made available to the Department of

Anesthesiology, Department of Surgery and the administration of the Southern

Philippines Medical Center which may be used to enhance quality of patient care.

q. Extent of Use of Study Data

Data gathered will be used solely for the purposes as indicated in the objectives

and significance of the study. There are no intentions to use the data outside the scope of

the study.

r. Authorship and Contributorship

The main proponents of the study are the main authors and the principal investigators.

s. Conflicts of Interest
There are no conflicts of interest among the authors and contributors.

t. Publication

This study will be submitted to national and international publication groups for

possible publication. The authors and co-authors will be duly recognized in all

publications.

u. Funding

The expenses of the study will be shouldered by the primary investigators.

v. Duplicate Copy of Informed Consent Form

A duplicate of the informed consent form will be given to participants.

w. Questions and Concerns regarding the study

The primary investigators are open should there be any questions and concerns regarding

the study. The participants will be able to contact the primary investigators regarding

questions and concerns

x. Contact Details

For questions and concerns, the primary investigators may be reached through their

mobile numbers, Christine Alexis Dinopol, MD at 09615914525 and Maria Cecilia

Lomboy, MD at 09171245229.
 DUMMY TABLES

Table 1. Sociodemographic and clinical profile of participants at Southern Philippines

Medical Center (N=43)

Variables Frequency

Sex Male

Female

Age 18-30

31-40

41-50

51-60

Educational Status No formal education

Primary

Secondary

Higher Education

Marital Status Single

Married

Separated

Anesthetic Technique General Anesthesia Only

General Anesthesia with

Neuraxial Anesthesia

General Anesthesia with

Regional Anesthesia

Neuraxial Anesthesia

ASA Status ASA I

ASA II

ASA III
Surgical Duration Less than 2 hours

Within 2 to 4 hours

More than 4 hours

Table 2. Level of Satisfaction of participants according to themes

Themes Mean Standard Description

Deviation

Trust and atmosphere

Fear

Discomfort

Treatment by Personnel

Information and Waiting

Table 3. Associated Factors for High Level of Satisfaction

Variables Odds 95% CI P value

Ratio

Sex Male

Female

Age 18-30

31-40

41-50
 51-60

Educational Status No formal education

Primary

Secondary

Higher Education

Marital Status Single

Married

Separated

Anesthetic General Anesthesia Only

Technique
General Anesthesia with Neuraxial
Anesthesia

General Anesthesia with Regional

Anesthesia

Neuraxial Anesthesia

ASA Status ASA I

ASA II

ASA III

Surgical Duration Less than 2 hours

More than 2 hours

Long Waiting Yes

Time
No

Information Given Yes

by
Anesthesiologist No

Experienced Fear Yes

and Anxiety
before the No
procedure

Good care of staff Yes

members No

Emergence Comfortable
Experience
Not comfortable

Postoperative Yes
Nausea and
Vomiting No

APPENDIX A

Table 1. The Heidelberg Peri-Anesthetic Questionnaire in English

Questions Strongly Satisfied Dis- Strongly

Satisfied Dissatisfied
satisfied
1.The waiting time before the
consultation of the anesthetist for
informed consent was long

2. The information was given in a

pleasant environment (waiting
room)

3. The informing doctor should be

friendlier

4.The anesthetist doctor appeared to

be under time pressure during the
consultation

5.The anesthetist doctor did not give

enough information

6. The information given was

understandable

7. Fear of anesthesia played an

important role

8. Fear of surgery played an

important role

9. The night before surgery felt

relaxed
10. The surgery was postponed for
another day

11.Prior to the procedure fear to the

point of losing control was felt

12. The waiting time the morning

before the surgery was long

13. The feeling of being left alone

caused stress

14. In general, fear or agitation played

an important role in the time prior to
anesthesia

15. Thirst before the anesthesia was a

problem

16. Feeling cold and shivering was

experienced in the room where the
anesthesia was applied

17. Pain prior to the anesthesia cause

stress
18. The anesthesia went exactly as the
doctor had advised

19. The atmosphere was pleasant in

the anesthesia room

20. Staff members took good care of

and were responsive while anesthesia
was applied

21. Waking up from anesthesia was

comfortable

22. After waking up from anesthesia

pain was experienced in the area of
surgery

23. Little or no pain was experienced

in other areas (e.g. the head)
following the surgery

24.Staff members showed they were

seriously concerned about my pain

25. The staff quickly alleviate my

pain

26. Nausea or vomiting was a

problem following anesthesia
 27. Hoarseness or a sore throat was a
problem following anesthesia

28. Weakness of the muscles was a

problem following anesthesia

29. Thirst was a problem following

anesthesia

30. An urgent need to urinate was a

problem following anesthesia

31. Feeling cold or shivering were

problems following the anesthesia

32. It was hard to breathe following

the anesthesia

33. Fatigue or inability to concentrate

was a problem after anesthesia

34. Immediately after waking staff

members were available and
responsive to me

35. Anesthesia staff in the recovery

room or intensive care were friendly

36. The recovery following

anesthesia went well
 37. You can trust the anesthesia staff

38. You can be sure that the

anesthesiologist was making
decisions in the best interest of the
patient

Table 2. Heidelberg Peri-Anesthetic Questionnaire in Cebuano

Questions Pinaka- Importante Dili Dili

Para uyon Gayud
importane Kanako Makauyon
Para
Kanako

1.Dugay ang oras sa paghulat sa

doctor para sa konsultasyon ug
paghatag ug pahibalo sa pag-uyon

2.Ang kasayuran gihatag sa usa ka

maanindot nga palibot (lawak nga
hulatanan)
3. Ang nagapahibalo ng doktor
kinahanglan ng mas mahigalaon

4. Makitaan ug kapit-os sa panahon

atol sa konsultasyon ang Doktor sa
Anesthesia

5.Ang doktor sa anesthesia wala

mihatag ug igong kasayuran

6. Ang kasayuran nga gihatag

masabtan

7. Ang kahadlok sa anesthesia

adunay usa ka importante nga papel

8. Ang kahadlok sa pag-opera

adunay importante nga papel

9. Kalmado ra ang gibatiang gabii

saw ala pa ang operasyon

10. Ang pag-opera gibalhin sa laing

adlaw

11. Sa wala pa ang operasyon,

kahadlok sa punto nga mawad-an sa
control ang gibati
12. Taas ang oras sa paghulat anang
buntag sa wala pa ang operasyon

13. Ang pagbati nga gibiyaan nga

nag-inusara nakapahimo sa tension

14. Sa kinatibuk-an, ang kahadlok o

kahasol sa pagbati adunay
mahinungdanong bahin sa panahon
sa wala pa ang anesthesia

15. Usa ka problema ang kauhaw sa

wala pa ang anesthesia

16. Ang pagbati nga bugnaw ug

nagkurog nasinati diha sa lawak sa
dihang ang anesthesia gipadapat

17. Ang sakit nga gibati sa wala pa

ang anesthesia maoy hinungdan sa
stress o tension

18. Ang anesthesia naihatag sama

sa tambag sa doctor

19. Nindot ang palibot ug

kasinatian sa lawa sa kung asa
gihatag ang anesthesia
20. Ang mga sakop sa staff nag-
atiman ug maalagaron samtang ang
anesthesia nakadapat

21. Komportable ang pagmata

gikan sa anesthesia

22. Human makamata gikan sa

anesthesia, nasinati ang sakit dapit
sa operasyon

23. Diyutay o walay kasakit nga

nasinati sa ubang mga parte sa
lawas (sama sa ulo) human sa
operasyon

24. Gipakita sa mga kawani (Staff)

nga sila nabalaka ug moatiman pag-
ayo sa akong kasakit

25. Ang kawani dali nga

nakapahupay sa akong kasakit

26. Ang kasinatian sa

pagkakasukaon o pagsuka usa ka
problema human sa anesthesia

27. Ang sakit nga tutunlan usa ka

problema human sa anesthesia

28. Ang kahuyang sa kaunuran usa

ka problema human sa anaesthesia
29. Ang kauhaw usa ka problema
human sa anesthesia

30. Ang usa ka dinalian nga

panginahanglan sa pag-ihi usa ka
problema human sa anesthesia

31. Ang pagbati nga tugnaw o

pagkurog mao ang problema human
sa anesthesia

32. Lisud nga makaginhawa human

sa anesthesia

33. Ang kakapoy o kawalay katakus

sapag concentrate usa ka problema
human sa anesthesia

34. Diha-diha dayon human sa

pagmata ang mga miyembro sa
kawani anaa ug nag-alagad kanako

35. Ang kawani sa anesthesia sa

lawak sa pagkaayo o sa intensive
care mahigalaon

36. Walay ngil-ad nga nahitabo sa

dihang nagapaayo human sa
anesthesia
37. Makasalig ka sa kawani sa
anesthesia

38. Makasiguro ka nga ang doctor

nga nagahatag sa anesthesia
naghimo sa mga desisyon sa labing
maayong interes sa pasyente
 APPENDIX C

INFORMED CONSENT FORM

SA MGA PASYENTE NGA GIDAPIT NGA MO-PARTICIPATE SA PAGTUON NGA

"PATIENT SATISFACTION WITH ANESTHESIA CARE AMONG OPEN

CHOLECYSTECTOMY PATIENTS IN A TERTIARY HOSPITAL IN THE
PHILIPPINES”

Ngalan sa Principal Investigator: Christine Alexis Dinopol, MD ug Maria Cecilia Lomboy, MD

Ngalan sa Organisasyon: Department of Anesthesiology, Southern Philippines Medical Center

Mga Sponsor: Wala/None

Adunay ihatag nga kopya sa kompletong Informed Consent Form.

Unang Bahin: Informatin Sheet

A. Pasiuna

Kami, si Dr. Christine Alexis S. Dinopol ug Dr. Maria Cecilia J. Lomboy, gikan sa
Department of Anesthesiology sa Southern Philippines Medical Center, nagpahigayon ug
pagtuon bahin sa satispaksyon sa pagpangandam sa anesthesia sa mga niagi sa operasyon na
open cholecystectomy ning maong ospital. Kami maghatag og impormasyon mahitungod niini
nga research ug gidapit ka nga moapil sa pagtuon. Dili kinahanglan nga ikaw magdesisyon
dayon nga dawaton o balibaran kini nga imbitasyon. Mahimo nimong kami nga pangutan-on
kung adunay kay mga pangutana sa ulahi.

B. Katuyoan

Ang anesthesia service adunay dakong bahin sa pagkakontento sa mga pasyente sa surgery
sa sistema sa healthcare sa usa ka ospital. Gusto namong mahibal-an kung ang among mga
pasyente nalipay sa among mga serbisyo sa wala pa ang operasyon, sa panahon, ug pagkahuman
sa operasyon. Pinaagi niini, among masayran kon unsaon nato pagpalambo sa mga serbisyong
ihatag namo sa mga umaabot nga pasyente.

C. Klase sa Interbensyon sa Pagtuon

Kini nga pagtuon maglakip sa imong partisipasyon sa usa ka interbyu ug pagtubag sa usa ka
questionnaire nga mokabat sa nga napulo (10) ngadto sa kinse (15) ka minute sa kinatibuk-an.

D. Pagpili sa Partisipante
 Giimbitahan ang imong partisipasyon niining pagtuon tungod nakapasar ka sa criteria sa
pagtuon

E. Boluntaryong Pag-apil
Ang imong pag-apil sa kini nga pagtuon hingpit nga boluntaryo. Anaa kanimo kung ikaw
moapil ba o dili. Kung gipili nimo nga mobalibad, ang tanan nga mga serbisyo nga imong
madawat niining ospital magpadayon ug wala’y mabag-o.

F. Mga Pamaagi
Kung dawaton nimo ang among imbitasyon sa pag-apil niining pagtuon, kami muhangyo
sa imong pagtubag sa mga pangutana pinaagi sa usa ka interview.

G. Mga Risgo/Risks
Adunay usa ka risgo nga mahimong mahisgutan ang pipila ka personal o kompidensyal
nga butang. Dili nimo kinahanglan nga tubagon ang bisan unsang pangutana kung dili ka
komportable sa paghisgot bahin niini.

H. Mga Kaayohan
Wala'y direktang kaayohan kanimo kining pagtuon, apan ang imong pag-apil lagmit
makatabang kanamo sa pagpauswag sa among mga serbisyo ug pag-atiman sa mga umaabot na
pasyente isip mga anesthesiologist.

I. Reimbursement

Dili ka hatagan og bisan unsang insentibo sa pag-apil sa interbyu.

J. Pagkompidensyal

Ang impormasyon nga among makolekta himoong pribado.

K. Pagpaambit sa mga Resulta

Walay bisan unsa nga imong isulti kanamo nga ipaambit ni bisan kinsa sa gawas sa
research team, ug walay bisan unsang impormasyon nga ipahinungod sa imong ngalan.

L. Katungod sa Pagbalibad o Pag-atras

Mamahimo kang mubalibad sa pag-apil niining pagtuon kung labag kini sa imong buot.
Mahimo kang muatras sa interbyu sa bisan unsang oras nga imong gusto. Ang pagbalibad dili
makaapekto sa mga serbisyo nga imong madawat gikan sa ospital.

M. Kinsa ang Kontakon

Kon duna kay mga pangutana, mahimo nimo silang pangutan-on. Kung gusto nimo
mangutana human sa interbyu, mahimo nimong kontakon ang bisan kinsa sa mga musunud:
Dr. Christine Alexis Dinopol – 09615914525
Dr. Maria Cecilia Lomboy – 09171245229
Ikaduhang Bahin: Sertipiko sa Pag-uyon

Nabasa ko na ang naunang impormasyon, o gibasa na kini kanako. Nakahigayon ko sa

pagpangutana bahin niini. Ako boluntaryong mitugot nga mahimong partisipante niini nga
pagtuon.

Naimprinta nga Ngalan Imabaw sa Pirma sa Petsa sa Pagpirma

Partisipante

Kung dili makabasa:

Akong nasaksihan ang tukma nga pagbasa sa pagtugot o consent form sa potensyal nga
partisipante, ug ang indibidwal adunay oportunidad sa pagpangutana. Akong gikumpirma nga
ang indibidwal naghatag ug boluntaryong pagtugot.

Naimprinta nga Ngalan Imabaw sa Pirma sa

Saksi

Petsa sa Pagpirma Thumb Print of

 Participant

Pahayag sa researcher/nagkuha sa pagtugot

Sakto nakong gibasa ang information sheet ngadto sa potensyal nga partisipante, ug
kutob sa akong mahimo, nakasiguro ko nga ang partisipante nakasabot sa iyang partisipasyon ug
papel niini nga pagtuon.

Giimprinta nga Ngalan Imabaw sa Pirma sa Petsa sa Pagpirma

Researcher nga Nagkuha sa Pag-tugot
Printed Name Over Signature of Researcher Taking the
Consent
APPENDIX D

GANTT CHART
 APPENDIX D
BUDGET

Expenses Cost

Printed materials P 5, 000.00

Statistician P 7, 000.00

Miscellaneous P 8, 000.00

Total P 20, 000.00

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