Promoting self-efficacy and decision-making confidence in regional anaesthesia; developing and testing an intervention to promote the uptake of awake

Regional anaesthetic (RA), often referred to as 'awake surgery', is a method of administering local or regional anaesthesia instead of a general anaesthesia (GA) for certain surgical procedures. The relative benefits of using RA over GA include fewer life-threatening perioperative complications1 , reduced risk of blood clots, improved analgesia, reduced postoperative nausea2

,shortened length of stay in post-anaesthesia care and increased operating room efficiency3 . Despite the well documented benefits and potential efficiencies of RA4 , the uptake challenges in the UK continue with only 14.5% of surgeries performed as awake surgeries5 . Given the potential benefits to patients, practitioners, and the healthcare system4

, there is a need to understand best practices for promoting the uptake of awake surgeries in the UK. Decision-making processes can be greatly supported by health psychology to target the underlying mechanisms of human behaviours6 and understand the aetiology, promotion, and maintenance of health to improve the quality of patient care7

. A range of psychological and attitudinal factors may contribute to the hesitation around awake surgeries among patients. These include anxiety about anaesthesia8 , patient-doctor trust 9 , sight and sounds of surgery10 and knowledge about the risks of GA11 . The Theory of Planned Behaviour (TPB)12,13, focuses on attitudinal and social determinants of behaviour to

predict, explain, and modify health behaviours14 . Personal attitudes, subjective norms and perceived behavioural control influence long-term behaviour12 . The TPB has been frequently applied to clinician and patient behaviour processes15 , and is a widely applied behavioural model used to influence health literacy, and decision-making16. Using the TPB, the overall aim

of this study is to increase study participants' self-efficacy and decision-making confidence to undergo RA procedures.