M. R. Thayer1, C. S. Young1, M. E. Rosenbaum2, M. R. Kapadia3 1University Of Iowa,Carver College Of Medicine,Iowa City, IA, USA 2University Of Iowa,Department Of Family Medicine,Iowa City, IA, USA 3University Of Iowa,Department Of Surgery,Iowa City, IA, USA
Introduction:
Families often play an essential role in the postoperative care of surgical patients. The conversation in the immediate postoperative period provides an opportunity for surgeons to communicate with families regarding patient status and care. Empirical investigations of postoperative communication practices with families have been limited to surgeon self-report, and there is a lack of primary observational data. The aim of this study was to broaden understanding of surgeon-family postoperative interactions through analysis of conversation content and structure.
Methods:
Conversations between surgeons and families in the immediate postoperative period were audio-recorded. The recordings were transcribed, coded, and analyzed using the QSR NVivo 10 program. An iterative process was utilized to identify content and themes of these conversations. Using a modified numerical EPSCALE, conversations were evaluated regarding general communication skills in explanation and planning (scored 0-3, with 0 indicating poor performance and 3 indicating excellent performance).
Results:
Postoperative conversations from 25 surgical cases were recorded and analyzed (N=10 surgeons). The majority of cases required inpatient admission (84%) and included bariatric, colorectal, surgical oncology, and minimally invasive procedures. The average conversation length was 4 minutes (range 1-7), and family members present ranged from 1 to 3. Subject matter pertaining to what happened during surgery, surgical outcome, and short-term postoperative course were addressed in nearly every discussion (100%, 96%, 92%, respectively). Surgeons provided opportunities for family inquiry in 87% of encounters, primarily at the completion of, rather than during, the conversation. Family members asked an average of 4 questions per conversation, generally related to the short-term postoperative course (30%), what happened during surgery (25%), and logistics on visiting the patient (16%). While postoperative conversations often included organized explanation, opportunities for family contribution, and chunking/checking, they differed from other information-sharing conversations in not typically incorporating starting point assessment (2/25 cases) and explicitly checking for family understanding (3/25 cases).
Conclusion:
This study presented an initial assessment of the contextual and structural patterns of postoperative conversations with families. It was demonstrated that similar content areas are addressed in these conversations. However, surgeons often do not employ many of the recommended communication skills for effective explanation and planning. This suggests that postoperative conversations are conceivably different from other information-sharing interactions. These findings have the potential to contribute to the development of surgical educational training materials.