What should lung cancer patients know before surgery? A Delphi consensus study

Objective: Preoperative patient education improves surgical outcomes but high variability of existing patient education materials (PEMs) exists. This study establishes thoracic surgeon consensus on essential content included in PEMs to help patients to prepare for lung cancer surgery. Methods: Board-certified thoracic surgeons were recruited to participate through email invitations. Statements about the inclusion of topics in preoperative PEMs were crafted and divided into 6 categories. During 3 rounds of Delphi voting, surgeons gave anonymized feedback, and statements were iteratively revised. Results and comments of each round were shared with all surgeons for the next round of voting. Statements were considered to reach consensus if they achieved more than 80% agreement. Thematic qualitative analysis was performed on the comments provided. Results: A total of 41 board certified thoracic surgeons averaging 17.1 years in practice and 133 lung resections per year were recruited. Response rates were 93% (38 out of 41) for round 1, 88% (34 out of 38) for round 2, and 91% (31 out of 34) for round 3. The initial 25 statements were revised into 19 statements, of which 13 (68%) reached consensus. Statements with details about the operation itself had the highest consensus, whereas details about the day of surgery and recovery had the lowest consensus rates. Thematic analysis showed that statements were likely to be accepted if they were supported by evidence to improve surgical outcomes, set patient expectations, or alleviated anxiety. Statements were likely to be rejected if they were perceived to be irrelevant, could vary depending on practice, or could overwhelm patients. Conclusions: This study provides consensus-based guidelines on content that should be included in preoperative lung cancer surgery PEMs from thoracic surgeons’ perspective. Surgeon consensus gives valuable insight on topics that need expert opinion, whereas other topics require patient input. Patient preferences should be evaluated before finalizing guidelines.