It's big surgery: preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations. Ann Surg 2014 Mar;259(3):458-63
Date
11/21/2013Pubmed ID
24253139Pubmed Central ID
PMC3936655DOI
10.1097/SLA.0000000000000314Scopus ID
2-s2.0-84894089408 (requires institutional sign-in at Scopus site) 119 CitationsAbstract
OBJECTIVE: To identify the processes, surgeons use to establish patient buy-in to postoperative treatments.
BACKGROUND: Surgeons generally believe they confirm the patient's commitment to an operation and all ensuing postoperative care, before surgery. How surgeons get buy-in and whether patients participate in this agreement is unknown.
METHODS: We used purposive sampling to identify 3 surgeons from different subspecialties who routinely perform high-risk operations at each of 3 distinct medical centers (Toronto, Ontario; Boston, Massachusetts; Madison, Wisconsin). We recorded preoperative conversations with 3 to 7 patients facing high-risk surgery with each surgeon (n = 48) and used content analysis to analyze each preoperative conversation inductively.
RESULTS: Surgeons conveyed the gravity of high-risk operations to patients by emphasizing the operation is "big surgery" and that a decision to proceed invoked a serious commitment for both the surgeon and the patient. Surgeons were frank about the potential for serious complications and the need for intensive care. They rarely discussed the use of prolonged life-supporting treatment, and patients' questions were primarily confined to logistic or technical concerns. Surgeons regularly proceeded through the conversation in a manner that suggested they believed buy-in was achieved, but this agreement was rarely forged explicitly.
CONCLUSIONS: Surgeons who perform high-risk operations communicate the risks of surgery and express their commitment to the patient's survival. However, they rarely discuss prolonged life-supporting treatments explicitly and patients do not discuss their preferences. It is not possible to determine patients' desires for prolonged postoperative life support on the basis of these preoperative conversations alone.
Author List
Pecanac KE, Kehler JM, Brasel KJ, Cooper Z, Steffens NM, McKneally MF, Schwarze MLMESH terms used to index this publication - Major topics in bold
AdultAdvance Directive Adherence
Advance Directives
Aged
Aged, 80 and over
Attitude of Health Personnel
Decision Making
Female
Humans
Male
Middle Aged
Physician-Patient Relations
Preoperative Care
