K. Guyton1, C. Smith2, A. Langerman1, N. Schindler1,3 1University Of Chicago,Surgery,Chicago, IL, USA 2University Of Chicago,Pritzker School Of Medicine,Chicago, IL, USA 3Northshore University Health System,Surgery,Evanston, IL, USA
Introduction:
Awake surgery offers patients an efficient and cost-effective alternative to procedures under general anesthesia. Surgeon-patient communication during awake procedures is an important component of the overall patient experience and has been inadequately described in the literature.
Methods:
Surgeons who perform a high volume of procedures on awake (no sedation or conscious sedation) patients were identified at two medical centers. Surgeons were contacted via email to participate in audio-recorded semi-structured interviews. Interviews were continued until saturation was reached. Review of transcripts allowed for iterative development of themes by two researchers; discrepancies were resolved by consensus.
Results:
Fifty two percent of surgeons agreed to participate, consisting of 23 faculty from 8 surgical specialties. Surgeons describe the primary drivers to perform awake procedures as decreased physiologic and monetary patient impact and increased procedure efficiency, while anticipated emotional, sensory and physical responses are deterrents. Surgeons emphasize that pre-procedure expectation management and a calm environment are integral contributors to the patient experience. Intra-procedure surgeon-patient communication is focused on providing instructions, verifying patient comfort, alerting the patient to changes in stimulation, diverting patient attention, and using words that do not cause patient alarm. Surgeon communication with staff and trainees is modified with an awake patient: verbal exchanges are minimized and quiet or nonverbal communication is utilized. With less explicit communication, surgeons value working with consistent teams. Trainee presence decreases focus on the patient. All surgeons report an absence of formal training in awake communication skills and report development of their techniques through observation of mentors and trial and error. Numerous surgeons report feeling insecure in their techniques and cite interest in learning other awake communication methods.
Conclusion:
Awake surgical procedures are unique circumstances for doctor-patient communication. Surgeons cite varied techniques to prepare and reassure patients before and during the procedure. Inconsistent education in communication skills results in surgeon insecurity. Challenges with trainee involvement warrant further evaluation of teaching practices, surgeon-trainee communication and the effect on patients during awake procedures. Development of best practices and a formalized curriculum in awake procedure communication would offer surgeons useful guidance for optimizing patient experience.