Table 3. Representative quotations demonstrating surgeons’ communication priorities.
These priorities include: 1. Clarifying operative intent, 2. Disclosing uncertainty, and 3. Establishing prognostic alignment.
| Themes | Representative Quotations |
|---|---|
| Clarifying Intent | I tell them it’s not curative, and I identify the focus that the intervention is for. If the focus is a bowel obstruction, then I make sure they understand that it’s a bowel obstruction that they’re getting an operation for…There’s a finite point of attack, a hard target, and there is a finite expectation.” (Participant #8) |
| “But I think the patient needs to be educated in the process and be able to know what your thought processes are so they can follow along.” (Participant #5) | |
| “[P]articularly for people who aren’t surgeons, there is this sort of, ‘Is it curative or is it palliative?’…I think not just for the patients, I think for the whole care team, being able to sort of pull out that the intent is control and not cure would be helpful.” (Participant #17) | |
| “[O]ne of the first things you dictate in a surgical note is…’What’s the indication?’ This is being done for diagnostic purposes. This is being done for potentially therapeutic purposes. So if we’re putting that in our notes, shouldn’t we be having that conversation with the patients?” (Participant #5) | |
| Disclosing Uncertainty | “Informed consent is a very charged term. It’s hard to, really, I don’t have enough information to know what’s always the right answer…But at least you’ve given them that opportunity to consider what really can be expected and what might be too much to expect.” (Participant #13) |
| “[T]he likelihood of cure is extremely low…And I need you to understand that before we sign up to do this together.” (Participant #2) | |
| “I would also describe the ways in which we wouldn’t be able to necessarily predict the trajectory of the metastatic growth.” (Participant #1) | |
| Establishing Alignment | “What is our goal? Our goal is to keep you from having to come back to the hospital, hopefully getting you to eat again…So do a colostomy, you know making sure they’re okay with what a colostomy means…and say, ‘Is that trade-off worth it to you[?]’…and just make sure that their goals and understanding is aligned with what we’re offering….I think if everyone’s on the same page, you know as long as we’re all aligned and everybody’s upfront and straightforward and knows what we’re all agreeing to do, then I think it comes down to really the patient is the boss.”” (Participant #5) |
| “I think documenting the intent of the operation, particularly for cancer, is really important…[Y]ou need to know if the outcome of that operation really aligned with what the patient’s goals are.” (Participant #6) | |
| “The only thing that I find helps me when I’m thinking about these concepts is the knowledge of…why I’m doing it and how aggressive I should be surgically because that helps me align with my patients and their goals.” (Participant #7) |