M. J. Nabozny1, J. M. Kruser2, K. E. Pecanac7, E. H. Chittenden5, Z. Cooper6, N. M. Steffens1, M. F. McKneally8,9, K. J. Brasel10, M. L. Schwarze1,4 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA 2Northwestern University,Department Of Medicine,Chicago, IL, USA 4University Of Wisconsin,Department Of Medical History And Bioethics,Madison, WI, USA 5Massachusetts General Hospital,Division Of Palliative Care,Boston, MA, USA 6Brigham And Women’s Hospital,Division Of Trauma, Burns, And Surgical Critical Care,Boston, MA, USA 7University Of Wisconsin,School Of Nursing,Madison, WI, USA 8University of Toronto,Department Of Surgery,Toronto, Ontario, Canada 9University of Toronto,Joint Center For Bioethics,Toronto, Ontario, Canada 10Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA
Introduction: Before a big operation surgeons generally assume that patients buy-in to life-supporting interventions that might be necessary postoperatively. How patients understand this agreement and their willingness to participate in additional treatment is unknown. The objective of this study is to characterize how patients buy-in to treatments beyond the operating room and what limits they would place on additional interventions.
Methods: We performed a qualitative study of preoperative conversations between surgeons and patients at surgical practices in Toronto, ON, Boston, MA, and Madison, WI. Purposive sampling was used to identify 11 surgeons who are good communicators and routinely perform high-risk operations. Preoperative conversations between each surgeon and 3-7 of their patients were recorded (n = 89). A subset of 41 patients and their family members were asked to participate in open-end preoperative and postoperative interviews. We used qualitative content analysis to analyze the interviews and surgeon visits inductively, specifically evaluating the content of the conversation about the use of postoperative life support.
Results: Thirty-three patients and their family members participated in a preoperative interview and two of these were lost to follow-up. Patients expressed confidence that they had a common understanding with their surgeon about how they would be treated if there was a postoperative complication. However, this agreement was expressed in a variety of ways from an explicit desire that the surgeon would treat any complication to the fullest extent, “Just do what you got to do” to a simple assumption that complications would be treated if they did occur. Most patients trusted their surgeon to intervene on their behalf postoperatively but expressed a preference for significant treatment limitations which were not discussed with their surgeon preoperatively (See Table). Furthermore, patients did not discuss their advance directive with their surgeon preoperatively but assumed it would be on file and/or that family members knew their wishes.
Conclusion: Following high risk surgery, patients trust their surgeon to treat complications as they arise. Although patients buy-in to additional postoperative intervention, they note a broad range of preferences for treatment limitations which are not discussed with the surgeon preoperatively.
