Try as you might to ignore social media, it will find you out. Now that the main offerings revolve increasingly around the well-known trio of Facebook, Twitter and LinkedIn, e-communication tools are part of the fabric of life and are being used for purposes never imagined a few short years ago. The clinical setting has not been left out of this revolution.
For example, the American Society of Plastic Surgeons (ASPS) recently studied the benefits of text messaging between surgeon and patients undergoing breast reconstruction after mastectomy. It found that messaging can promote improvements in post-operative outcomes.
The claim was based on a study at the University of Texas Southwestern Medical Center, Dallas, where 102 women were split into control and ‘intervention’ groups. In this latter group, the subjects were routinely updated as to their progress by text, while not losing the options of conventional face-to-face consultations.
And in a step that nods to the value of the self-management of conditions as an aid to speedier recovery and improved quality of life, after leaving hospital the intervention arm participants were encouraged to text their fluid drain levels to clinicians, and were instructed as to next steps by return text. The study, led by Dr Roshni Rao, has significant implications, including with regard to change management for care delivery.
More immediately, the key benefits of the Dallas study are two-fold. It has shown that:
- Patients willing to become involved in the self-management of their conditions feel more in control and are likely to experience better outcomes. This applies not only to inpatient breast reconstruction, but is also relevant across the field of clinical applications — as the £30 million UK telehealth/telecare trial, the Whole System Demonstrator (WSD), is now showing
- Significantly, although not without its own issues, the study has done much to raise awareness of breast reconstruction post-mastectomy, which is a procedure that many feel receives insufficient attention.
To the credit of the US study controllers, they overcame significant hurdles in completing their work, including issues with regard to patient confidentiality, which meant patients could text only the requested information during specified hours; concerns about how to reimburse the service (the question of who ‘owns’ the patient); and how to integrate the findings into e-health records.
While these comments have merit, of significant importance is that the study was run — and that it was run in breast operation patients.
The American Cancer Society reports that 292,000 US women face breast cancer every year, but their post-surgery options are now wider than in the past, and include breast conservation surgery (lumpectomy/or segmental mastectomy) as well as mastectomy1. For many, this is followed by reconstructive surgery, which is carried out for a number of, sometimes complex, reasons, but it usually (though not always) results in improved body image and self-esteem.
The fourth and final report of the UK’s National Mastectomy and Breast Reconstruction Audit, published in 2011, notes that there are still serious issues to confront with regard to breast reconstruction. It highlights that while breast reconstruction rates have increased in the UK, access to the procedure varies widely across the country. The UK report, prepared by a group of 10 specialists, including four from the Royal College of Surgeons of England, noted that:
- The quality and availability of pre-operative information must be improved to enable women to understand the physical impact of surgery
- Surgeons and clinical teams need to support and help their patients make these often difficult choices
- Complication rates and levels of post-operative pain are much higher than expected.
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