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Instructions for Writing Fact Sheets: Treatments and Procedures A fact sheet is a 1- to 4-page document that provides basic facts about a procedure or treatment. It should focus on the most important things for patients and families to know and do, including: What the procedure is and how it’s performed What to expect before, during, and after Information about risks, benefits, and alternatives that will support informed consent Basic discharge and home-care instructions General instructions for writing: The purpose of the fact sheet is to inform and reassure the patient about what will happen. The best way to do this is to write in the same straightforward and conversational tone you use when speaking to the patient. You can do this when you: Speak directly to the patient in a conversational tone, using words such as you, your doctor, your appendix (or other body part), etc. Use simple, non-specialized vocabulary when possible. Define new or more difficult vocabulary when necessary. A colonoscope is a long, thin tube with a tiny camera at the end. Each heading poses a question. Try to answer the question in the first sentence. What is it? It is a test to help determine the cause of your pain. Use active voice most of the time. Your doctor will remove the tissue. Be brief. Try to keep sentences and paragraphs short. Use the amount of space on this worksheet as a guide for the length of each section. These are recommendations for writing a fact sheet. Use your own best judgment about what the patient needs to know and how to discuss it. Once you’ve completed this worksheet, submit it to Patient and Provider Publications at [email protected], or to the writer who is working with your team. 1 Instructions Example: Laparoscopic Appendectomy Briefly describe the procedure, including the general category in which it falls (surgery, treatment for a condition, procedure to diagnose a problem, etc). This will distinguish it from diseases or conditions. An appendectomy is a surgery to remove your appendix. The appendix is a small pouch of tissue attached to the lower right side of your colon. It has no known function, and living without an appendix causes no known health problems. What is it? If necessary, introduce the basic idea of how this procedure is performed. (You will be able to provide more detail later.) Introduce the key body parts, tools, or terms necessary to understand this fact sheet. Write your text here Traditionally, an appendectomy is performed through an incision (opening) on the right side of the lower abdomen. In laparoscopic appendectomy, however, the surgery is performed through 3 or 4 very small (¼- to ½inch) incisions. A long tube with a tiny camera at the end (a laparoscope) will show an enlarged image of the procedure on a screen. The laparoscope has small surgical instruments that your surgeon will use to remove your appendix. Illustration (optional) Torso showing large and possibly small intestine, and appendix. Describe an illustration that will orient the patient to where or how the procedure is done. Identify what body parts should be labeled, or what you want to emphasize. Suggest a caption. Caption: The appendix is located near the place where the small intestine meets the large intestine (colon). The Patient and Provider Publications team will provide an illustration for your fact sheet. 2 Instructions Why do I need it? Briefly describe the symptoms or conditions which this procedure is meant to treat. Describe what this procedure allows the doctor to see, do, remove, test for, etc. If the procedure involves taking tissue or other samples, describe what the doctor will do with them Example: Laparoscopic Appendectomy Write your text here You need an appendectomy if you have appendicitis, a condition in which your appendix has become infected and inflamed. Symptoms can include: Abdominal pain, first near the navel, then moving to the lower right Loss of appetite Nausea or vomiting Abdominal swelling Constipation or diarrhea If your appendix is not removed soon enough it can burst and cause greater infection and even death. Your doctor may recommend laparoscopic appendectomy if your appendicitis has been identified early and your appendix has not burst. If the infection is already advanced or your appendix has burst, your doctor will likely recommend a traditional approach using a larger incision. Your doctor may also recommend traditional surgery for other reasons. 3 Instructions Example: Laparoscopic Appendectomy Benefits Benefits over traditional appendectomy include: List the potential benefits of having this procedure, possibly including: Less pain after surgery Expected outcomes If this is an alternative procedure, benefits of this procedure as compared to the related or more traditional procedure Risks List potential risks, possibly including: General risks related to anesthesia, or surgical procedures Risks specific to this procedure An indication of frequency of a particular risk such as “rare” or “3 in 1000 cases” A disclaimer such as, “Your doctor will do everything possible to give you the best results. Even so, not all outcomes will be successful.” Shorter hospital stay Faster return of bowel function and normal activities Smaller scars As with any surgery, complications sometimes occur. The risk of these complications is not greater than with a traditional open appendectomy. Bleeding Infection Blood clot in the lungs (very rare) A leak at the end of the colon where the appendix was removed Injury to nearby organs Alternatives List alternatives, possibly including: Traditional appendectomy (with one larger incision) Another procedure Once appendicitis starts, there is no known medical therapy. The appendix must be surgically removed. A statement such as “This procedure is usually done after non-surgical treatments have failed. These include medications, physical therapy, and watching and waiting.” Write your text here A statement such as: “If you feel your symptoms are not severe enough to have this procedure, tell your doctor.” 4 Instructions How do I prepare? (optional) If your are writing a 4-page fact sheet, you have room, or the procedure requires extensive preparation, you can start with instructions on how to prepare, such as What medications to stop before the procedure When to stop eating or drinking Whether to arrange for time off work or someone to drive them home Example: Laparoscopic Appendectomy Write your text here Take these steps to help your surgery and recovery go better: (example from Spinal Nerve Decompression) Stop smoking. If you smoke, try to stop before your surgery. Non-smokers have fewer complications related to surgery. More importantly, smoking slows bone healing and could cause your surgery to fail. Stop certain medications. Stop taking aspirin 2 weeks before surgery. Stop taking anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve) 1 week before surgery. Tell your surgeon if you are taking any blood thinners so your surgeon can help you stop these as well. Ask for time off work. Ask your doctor how long you may need to be off work, and make arrangements with your employer. Arrange for someone to drive you home. Ask for someone to drive you home from the hospital and to help you at home for the first few days. 5 Instructions Example: Laparoscopic Appendectomy What happens before? Describe the steps that come before the procedure, such as: An appendectomy is almost always an emergency surgery. When you get to the hospital: Pre-procedure interviews or tests Your doctor will examine you and ask you a series of questions about your symptoms and medical history. These measures help make sure that appendicitis is the cause of your symptoms. Anesthesia or pain-management preparations Where they will be (hospital or doctor’s office), what position they’ll lie in, etc. Write your text here You may also have blood tests and imaging tests (such as x-rays). You will be given a sedative to make you sleepy. An intravenous (IV) line will be attached to the back or your hand or your forearm so you can be given anesthesia. What happens during? Describe the basic steps of the procedure, possibly including: Catheters that will be inserted and what they’ll be used for Where incisions will be made Tools that will be used How the problem will be treated How the procedure will end Once you’re in the operating room: Your doctor will make a small incision in your abdomen and insert a narrow tube, called a cannula. A laparoscope (a long tube with a video camera at the end) will be inserted through the cannula. This projects an enlarged image of the inside of your abdomen to a screen. Two or three other small openings will be made in your abdomen, and cannulas will be inserted. These help position tools that so the appendix can be removed. The doctor will remove the appendix and close the incisions. 6 Instructions What happens after? Describe what the patient can expect to experience after the procedure, possibly including: What kind of pain they will have and how long it should last How pain will be managed Other side effects When they can go home Example: Laparoscopic Appendectomy Write your text here Most patients go home the day of the surgery. When you go home: You will be given oral pain medication. You may have shoulder or neck pain for the first 2 or 3 days after surgery. The pain may get better if you change positions. You may have cramping for the first several days, or your abdomen may feel swollen. You may have a sore throat for 1 to 2 days. This is caused by the breathing tube used during surgery. If you’re a woman, you may have some vaginal bleeding. If you do, use pads, not tampons. You may have a small amount of bleeding from your surgical incisions. What do I do when I get home? How long to rest Once you get home, take these steps to make your recovery go better: Appropriate recovery activity Rest on the day of the surgery. When to return to work or other normal activity After that, get up and walk around 4 to 5 times a day. This will decrease the risk of blood clots in your legs and soreness in your muscles. How to manage pain at home Increase the time and distance that you walk each day. Return to normal activity when your doctor allows. 7 Instructions When should I call my doctor? List symptoms that may require a doctor’s attention Do not include normal side effects that are not dangerous Example: Laparoscopic Appendectomy Write your text here Contact your doctor if you experience any of the following: Severe abdominal pain, or pain you can’t control Severe bloating or swollen stomach Chills, or fever above 101° Nausea or vomiting that doesn’t stop Bleeding from the rectum Increasing redness or pus draining from any of your incisions Inability to urinate (pee) 8 to 10 hours after surgery Feeling faint or light-headed even when lying down Frequently asked question (optional) If you have room, you may want to answer some commonly asked questions. (Example from Epidural with Colon Surgery) Will the epidural medication in my spine make my legs weak or make it difficult for me to walk? No. The pain medication will be given in an area of your spine that should not affect your ability to walk. How will I walk around if I am attached to a supply of pain medication? Your pain medication will be in a bag. The bag can hang on a pole that can roll along beside you as you walk. Your pain medication can go along with you as you do the walking necessary for your recovery. 8