Introduction
Autism is a neurodevelopmental difference that affects how a person communicates, interacts, and experiences the world. About 1-2% of people are autistic, and most of them are adults without intellectual disability. Many autistic people face challenges and barriers when they need healthcare, especially anaesthesia.
In this blog post, I will summarize a recent paper that proposes a simple framework for anaesthetists to provide better care for autistic patients.
What is autism and how does it affect anaesthesia?
Autism is not a disease or a disorder, but a spectrum of diverse and unique characteristics. Autistic people may have difficulties with social communication and interaction, sensory sensitivities, focused interests, and repetitive behaviours. These features may vary from person to person and from situation to situation. Autistic people may also have co-occurring medical conditions, such as epilepsy, anxiety, depression, or gastrointestinal problems.
Anaesthesia can be a stressful and overwhelming experience for autistic people, as it involves changes in routine, unfamiliar environments, sensory overload, and loss of control. Autistic people may have different responses to pain, sedation, and anaesthetic drugs. They may also have difficulties expressing their needs, preferences, and concerns, or understanding the information and instructions given by the anaesthetist. Therefore, anaesthetists need to be aware of the specific challenges and needs of autistic patients, and provide reasonable adjustments to accommodate them.
What is the SPACE framework and how can it help?
The SPACE framework is a mnemonic that stands for Sensory, Predictability, Anxiety, Communication, and Environment. It was originally developed by Doherty and colleagues for general healthcare settings, and adapted by Brown and colleagues for anaesthesia. The framework provides a simple and practical guide for anaesthetists to understand and support autistic patients, based on the following principles:
- Sensory: Autistic people may have heightened or reduced sensitivity to sensory stimuli, such as light, sound, touch, smell, or taste. Anaesthetists should ask about the patient’s sensory preferences and needs, and try to minimize or avoid sensory triggers that may cause discomfort or distress. For example, they can use headphones, sunglasses, weighted blankets, or aromatherapy to reduce sensory overload, or use gentle touch, verbal cues, or music to provide sensory feedback.
- Predictability: Autistic people may have difficulties coping with uncertainty, ambiguity, or change. Anaesthetists should provide clear and consistent information about what will happen before, during, and after the anaesthetic procedure, and follow the agreed plan as much as possible. They can also use visual aids, such as pictures, videos, or checklists, to help the patient understand the sequence of events and prepare for them. They should also inform the patient of any potential changes or delays, and explain the reasons and alternatives.
- Anxiety: Autistic people may experience high levels of anxiety, especially in unfamiliar or stressful situations. Anaesthetists should assess the patient’s anxiety level and sources, and provide appropriate interventions to reduce them. For example, they can use relaxation techniques, distraction methods, or positive reinforcement to help the patient cope with anxiety. They can also prescribe premedication or sedation if needed, but only with the patient’s consent and understanding of the effects and risks.
- Communication: Autistic people may have different ways of communicating, such as using words, gestures, signs, or symbols. Anaesthetists should ask about the patient’s preferred mode and style of communication, and adapt their own communication accordingly. They should use simple, concrete, and direct language, and avoid metaphors, sarcasm, or jokes. They should also check the patient’s comprehension and feedback, and repeat or rephrase the information if needed. They should also respect the patient’s right to silence or non-verbal communication, and not assume that they are uncooperative or uninterested.
- Environment: Autistic people may be affected by the physical and social environment of the anaesthetic setting, such as the temperature, lighting, noise, or people. Anaesthetists should try to create a comfortable and calm environment for the patient, and avoid unnecessary or unwanted stimuli. For example, they can adjust the temperature, lighting, or noise level, or provide a quiet or private space for the patient. They should also limit the number of people involved in the patient’s care, and introduce themselves and their roles clearly and politely.
Conclusion
Autism is a common and diverse neurodevelopmental difference that influences how a person experiences anaesthesia. Anaesthetists can improve the quality and safety of care for autistic patients by using the SPACE framework, which provides a simple and practical guide for understanding and supporting their sensory, predictability, anxiety, communication, and environment needs. By doing so, anaesthetists can help autistic patients have a more positive and less stressful anaesthetic experience.
Faq
What are the benefits of using the SPACE framework for anaesthetists?
The paper suggests that using the SPACE framework can help anaesthetists to provide better care for autistic patients, by improving their understanding, communication, and rapport with them. This can lead to increased patient satisfaction, trust, and compliance, as well as reduced anxiety, distress, and complications.
What are the challenges of implementing the SPACE framework in practice?
The paper acknowledges that there are some barriers and limitations to applying the SPACE framework in practice, such as time constraints, resource availability, staff training, and patient variability. The paper recommends that anaesthetists should use the framework as a flexible and adaptable guide, rather than a rigid and prescriptive protocol, and tailor it to the individual needs and preferences of each patient.
How can anaesthetists collaborate with other healthcare professionals to provide holistic care for autistic patients?
The paper suggests that anaesthetists should collaborate with other healthcare professionals, such as surgeons, nurses, psychologists, or therapists, to provide holistic care for autistic patients. Anaesthetists should share relevant information and recommendations with the multidisciplinary team, and coordinate the care plan and delivery. Anaesthetists should also seek advice or support from specialists or experts in autism, if needed.
What are the common misconceptions or myths about autism and anaesthesia?
The paper addresses some of the common misconceptions or myths about autism and anaesthesia, such as:
- Autistic people are always children or have intellectual disability.
- Autistic people are always uncooperative or aggressive.
- Autistic people do not feel pain or need analgesia.
- Autistic people cannot consent or refuse anaesthesia.
- Autistic people do not need or want communication or interaction.
The paper clarifies that these are false or inaccurate assumptions, and that autistic people are diverse and unique individuals, who have the same rights and needs as anyone else.
How can anaesthetists apply the SPACE framework to other patient groups or settings?
The paper indicates that the SPACE framework can be applied to other patient groups or settings, as it is based on the universal principles of person-centred care, reasonable adjustment, and human rights. Anaesthetists can adapt the framework to suit the specific needs and preferences of different patient groups, such as children, elderly, or people with intellectual disability, mental health conditions, or chronic pain. Anaesthetists can also use the framework in different settings, such as primary care, emergency care, or intensive care.
Source:
https://www.bjaed.org/article/S2058-5349(24)00007-6/fulltext?rss=yes