Elle L Kalbfell1, Anne Buffington1, Anna Kata2, Karen J Brasel3, Anne C Mosenthal4, Zara Cooper5, Emily Finlayson6, Margaret L Schwarze7. 1. Department of Surgery, University of Wisconsin, Madison, WI, USA. 2. Department of Surgery, Georgetown University Hospital, Washington D.C, USA. 3. Department of Surgery, Oregon Health and Science University, Portland, OR, USA. 4. Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA. 5. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 6. Department of Surgery, University of California, San Francisco, San Francisco, CA, USA. 7. Department of Surgery, University of Wisconsin, Madison, WI, USA. Electronic address: schwarze@surgery.wisc.edu.
Abstract
BACKGROUND: After serious postoperative complications, patients and families may experience conflict about goals of care. METHODS: We performed a multisite randomized clinical trial to test the effect of a question prompt list on postoperative conflict. We interviewed family members and patients age ≥60 who experienced serious complications. We used qualitative content analysis to analyze conflict and characterize patient experiences with complications. RESULTS: Fifty-six of 446 patients suffered a serious complication. Participants generally did not report conflict relating to postoperative treatments and expressed support for the care they received. We did not appreciate a difference in conflict between intervention and usual care. Respondents reported feeling unprepared for complications, witnessing heated interactions among team members, and a failure to develop trust for their surgeon preoperatively. CONCLUSION: Postoperative conflict following serious complications is well described but its incidence may be low. Nonetheless, patient and family observations reveal opportunities for improvement.
BACKGROUND: After serious postoperative complications, patients and families may experience conflict about goals of care. METHODS: We performed a multisite randomized clinical trial to test the effect of a question prompt list on postoperative conflict. We interviewed family members and patients age ≥60 who experienced serious complications. We used qualitative content analysis to analyze conflict and characterize patient experiences with complications. RESULTS: Fifty-six of 446 patients suffered a serious complication. Participants generally did not report conflict relating to postoperative treatments and expressed support for the care they received. We did not appreciate a difference in conflict between intervention and usual care. Respondents reported feeling unprepared for complications, witnessing heated interactions among team members, and a failure to develop trust for their surgeon preoperatively. CONCLUSION: Postoperative conflict following serious complications is well described but its incidence may be low. Nonetheless, patient and family observations reveal opportunities for improvement.
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