Patient Preferences for Chaperone Use During Plastic Surgery Physical Examinations
Nicholas G. Cuccolo, BS1, Dustin T. Crystal, BS1, Alisa O. Girard, BA, MA1, Milind Kachare, MD1, Kathy A. Zhang, BS1, Daphney Noel, BA1, Melat W. Tiruneh, BA, MBS1, Mary Cathryn Earnhardt, BA1, Bernard T. Lee, MD, MPH, MBA2, Jeremy Sinkin, MD1, Richard Agag, MD1.
1Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA, 2Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Purpose: Chaperone use serves two primary purposes: 1) to provide patient comfort in the setting of intimate physical exams, and 2) medico-legal protection of the physician. Despite these mutual benefits, there exists a gap in knowledge when looking at the subtleties of patient preferences, and this is particularly true for Plastic Surgery. The procedures in this field are incredibly varied, ranging from elective cosmetic procedures to urgent reconstructive surgery. As such, the patient population is equally as diverse, and there is no unifying attitude that would enable a one-size-fits-all approach to chaperone use. The aim of this study was to evaluate patient preferences regarding the use of chaperones during physical examinations, and to use this data to improve the quality of physical examinations with more patient-centered practices. Methods: Following IRB approval, a 26-question multiple-choice survey was administered to new and established patients. The survey includes questions concerning patient demographics, attitudes towards chaperone use, preferences regarding chaperone characteristics, and circumstances in which chaperone use feels appropriate. Patients were provided ten minutes of privacy to complete the survey, with the option to omit any questions they felt uncomfortable answering. A chart review was conducted in addition to the survey. Descriptive statistics were compiled, and Ordinal Logistic Regression was used to analyze trends in chaperone preferences. Results: A total of 67 surveys were completed, where 67% of respondents were female, 28% male, and 5% transgender. The majority of patients were white (72%) and non-Hispanic (81%), with the predominant religion being Catholic (46.3%), and an average age of 48 years. Overall, 51% of respondents wanted a chaperone present for their visit, 43% had no preference, and 6% did not want a chaperone. During examination of a sensitive area (e.g. breast, groin, buttock), patients deemed a chaperone was necessary always (25.4%), sometimes (37.3%), or rarely (10.4%), with 23.9% showing no preference. When the provider is of the opposite sex, a chaperone was necessary always (20.9%), sometimes (32.8%), and rarely (4.5%), with 32.8% showing no preference. Should a family member, significant other, or friend be present in the room, a cumulative 28.3% of patients felt that a chaperone should still be used. Same-sex chaperones were preferred by 33% of patients, while 61% had no preference. The duration of involvement with the practice was associated with a lower likelihood of wanting a chaperone (p=0.033), whereas patients with a diagnosis of cancer were significantly more likely to prefer a chaperone (p<0.001). Conclusion: Survey results demonstrate that over half of our patients prefer to have a chaperone present during physical examinations, with strong consideration of the sex of the provider and examination of sensitive areas. Additionally, patients with a difficult diagnosis or unfamiliarity with the practice may be more inclined to prefer a chaperone. These data reflect a gradient of chaperone preferences, and an opportunity to improve the quality of individualized care. Therefore, future considerations include an abbreviated chaperone survey, which will be implemented into our patients' initial paperwork and become part of the patient record and treatment protocol.
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