5 research outputs found
How patients and families describe major medical treatments: They are no longer living, just existing
Background: As more life-sustaining treatments become available, the need to provide patients and families clarity about what these treatments are and what they do is increasing. Little is known about how patients and families conceptualize life support.
Objective: To explore the discourse that patients and families used to describe major medical treatments in their accounts of treatment decision-making.
Methods: This study is a secondary data analysis of a survey sent to random addresses in Wisconsin regarding experiences with major medical treatment decision-making. This analysis includes the subsample of 366 respondents who specified the type of decision made in the survey\u27s open-ended questions. Inductive content analysis was used to qualitatively analyze the responses to the open-ended questions, with particular attention to how respondents described the treatment in their responses.
Results: Respondents\u27 descriptions showed a conceptualization of engaging in major medical treatments as keeping patients alive, whereas discontinuing or choosing not to engage in such treatments would bring about the patient\u27s death. However, respondents recognized the potential adverse consequences of engaging in major medical treatments, such as their capacity to cause pain or result in an undesirable neurologic state. Additionally, respondents described the limitations of such treatment regarding the uncertainty of the treatments providing the desired outcome or their uselessness in situations in which the patient\u27s death would be inevitable.
Conclusion: Understanding how patients and families make sense of major medical treatments can help clinicians during decision-making conversations
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It’s Big Surgery: Preoperative Expressions of Risk, Responsibility, and Commitment to Treatment after High-risk Operations
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 three surgeons from different subspecialties who routinely perform high-risk operations at each of three distinct medical centers (Toronto, ON; Boston, MA; Madison, WI). We recorded preoperative conversations with three to seven 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 based on these preoperative conversations alone