Home E-Weekly February 14, 2017

Surgeons Can Improve Communication With Patients

Published: February 13, 2017

FULL DISCLOSURE Surgeons should share what post-op life will really be like for patients.

Surgeons can better prepare patients for post-op recoveries by having frank discussions about what life will be truly be like after surgery, according to new research in published in JAMA Surgery.

Researchers assessed the conversations between 32 older patients scheduled for non-emergent surgery and 25 surgeons before and after the surgeons underwent a 2-hour training session on how to describe the best and worst case scenarios of surgical outcomes. After undergoing the training, half of the surgeons scored at least 74 on a 100-point scale of optimal communication, which was up from an average score of 41 among the surgeons before the training occurred.

Surgeons are taught to discuss the risks and benefits of surgery with patients in order to obtain informed consent, points out Lauren Taylor, MD, a general surgery resident in the department of surgery at the University of Wisconsin and first author of the study. "We commonly disclose risks in terms of a 25% chance of stroke or a 15% chance of renal failure," she explains. "But for many older adults considering high-risk surgery, this type of information is difficult to interpret in the context of their values and goals."

Dr. Taylor points out conversations about potential outcomes can be particularly challenging for surgeons given the acuity of surgical illness and lack of pre-existing relationship with patients. "Our research group wanted to provide a framework to help busy surgeons structure pre-op conversations in a way that promotes shared decision making," she says.

Surgeons who explained the best case and worst case scenarios of surgery changed the structure of discussions with patients, according to Dr. Taylor, who says surgeons must recognize that communications skills can be learned and practiced, just like the most complex surgical maneuvers. "Rather than disclosing isolated procedural risks, surgeons can help patients interpret these risks by describing what life might look like after surgery if everything went well, or what might happen if things go poorly," she adds. "These scenarios help patients prepare for adverse events and think about treatments in relation to their goals and values, such as preserving functional independence or spending time with family."

Daniel Cook

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