Identifying Patterns in Preoperative Communication about High-Risk Surgical Intervention: A Secondary Analysis of a Randomized Clinical Trial

Lily N. Stalter, Nathan D. Baggett, Bret M. Hanlon, Anne Buffington, Elle L. Kalbfell, Amy B. Zelenski, Robert M. Arnold, Justin T. Clapp and Margaret L. Schwarze
Additional contact information
Lily N. Stalter: Department of Surgery, University of Wisconsin–Madison, Madison, WI, USA
Nathan D. Baggett: HealthPartners Institute/Regions Hospital Emergency Medicine, St Paul, MN, USA
Bret M. Hanlon: Department of Surgery, University of Wisconsin–Madison, Madison, WI, USA
Anne Buffington: Department of Surgery, University of Wisconsin–Madison, Madison, WI, USA
Elle L. Kalbfell: Department of Surgery, University of Wisconsin–Madison, Madison, WI, USA
Amy B. Zelenski: Department of Medicine, University of Wisconsin–Madison, Madison, WI, USA
Robert M. Arnold: Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Justin T. Clapp: Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Margaret L. Schwarze: Department of Surgery, University of Wisconsin–Madison, Madison, WI, USA

Medical Decision Making, 2023, vol. 43, issue 4, 487-497

Abstract: Introduction Surgeons are entrusted with providing patients with information necessary for deliberation about surgical intervention. Ideally, surgical consultations generate a shared understanding of the treatment experience and determine whether surgery aligns with a patient’s overall health goals. In-depth assessment of communication patterns might reveal opportunities to better achieve these objectives. Methods We performed a secondary analysis of audio-recorded consultations between surgeons and patients considering high-risk surgery. For 43 surgeons, we randomly selected 4 transcripts each of consultations with patients aged ≥60 y with at least 1 comorbidity. We developed a coding taxonomy, based on principles of informed consent and shared decision making, to categorize surgeon speech. We grouped transcripts by treatment plan and recorded the treatment goal. We used box plots, Sankey diagrams, and flow diagrams to characterize communication patterns. Results We included 169 transcripts, of which 136 discussed an oncologic problem and 33 considered a vascular (including cardiac and neurovascular) problem. At the median, surgeons devoted an estimated 8 min (interquartile range 5–13 min) to content specifically about intervention including surgery. In 85.5% of conversations, more than 40% of surgeon speech was consumed by technical descriptions of the disease or treatment. “Fix-it†language was used in 91.7% of conversations. In 79.9% of conversations, no overall goal of treatment was established or only a desire to cure or control cancer was expressed. Most conversations (68.6%) began with an explanation of the disease, followed by explanation of the treatment in 53.3%, and then options in 16.6%. Conclusions Explanation of disease and treatment dominate surgical consultations, with limited time spent on patient goals. Changing the focus of these conversations may better support patients’ deliberation about the value of surgery. Trial registration: ClinicalTrials.gov Identifier: NCT02623335. Highlights In decision-making conversations about high-risk surgical intervention, surgeons emphasize description of the patient’s disease and potential treatment, and the use of “fix-it†language is common. Surgeons dedicated limited time to eliciting patient preferences and goals, and 79.9% of conversations resulted in no explicit goal of treatment. Current communication practices may be inadequate to support deliberation about the value of surgery for individual patients and their families.

Keywords: shared decision making; informed consent; surgery; communication (search for similar items in EconPapers)
Date: 2023
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X231164142 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:43:y:2023:i:4:p:487-497

DOI: 10.1177/0272989X231164142

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().