Comfort Contract for Patients

Designing a “Comfort Contract” to address patients’ expectations about postsurgical overall comfort and chronic discomforts is a thoughtful approach to patient-centered care. Here’s a template for creating such a contract:

Title: Comfort Contract for Post-surgical Care

Patient Information:

• Patient Name:
• Date of Birth:
• Surgeon’s Name:
• Date of Surgery:
• Emergency Contact:

Part 1: Expected Level of Postsurgical Overall Comfort In this section, the patient or their surrogate can specify the level of comfort they expect to achieve during the post-surgical recovery process. The scale can be from 1 to 10, where 1 represents the least comfort and 10 represents the highest comfort.

• I expect my overall comfort level during the post-surgical recovery to be: [1 to 10]

Part 2: Chronic Discomforts and Home Interventions In this section, the patient or their surrogate can list any chronic discomforts they experience on a regular basis. Additionally, they can specify the interventions they typically use at home to alleviate these discomforts. This information will help the medical team tailor the care plan accordingly.

1. Chronic Discomforts:
   • [Chronic Discomfort 1]
   • [Chronic Discomfort 2]
   • [Chronic Discomfort 3]
   • [etc.]
2. Home Interventions for Relief:
   • [Intervention 1]
   • [Intervention 2]
   • [Intervention 3]
   • [etc.]

Part 3: Additional Comments or Preferences This section allows the patient or their surrogate to express any other specific preferences or requirements regarding their comfort and care during the recovery period.

• [Additional Comments]

Part 4: Signatures By signing below, the patient or their surrogate acknowledges that they have discussed and completed this Comfort Contract with the medical team and that the information provided is accurate to the best of their knowledge.

Patient Signature: _______________________ Date: ___________

Surrogate Signature (if applicable): _______________________ Date: ___________

Disclaimer: The Comfort Contract is designed to enhance communication and patient-centered care. While the medical team will make every effort to meet the specified expectations and preferences, medical decisions and interventions may be subject to change based on the patient’s condition and medical needs during the recovery process.

This Comfort Contract will be kept in the patient’s medical record to ensure continuity of care and to facilitate appropriate follow-up with the patient’s designated healthcare providers.

Note: This template is a starting point and can be customized according to the specific needs and practices of the healthcare institution. The implementation of such a Comfort Contract would require discussions with legal and ethical experts to ensure compliance with applicable laws and regulations.