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A Surgeon’s Review for Difficult Conversations

  • SURGICAL EDUCATION (S. TISHERMAN, SECTION EDITOR)
  • Published:
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Abstract

Purpose of review

The goal of this review is to synthesize a strategy for difficult conversations using evidence from the literature and our experience in surgical and palliative care practice.

Recent Findings

Several published and established resources can inform surgeons’ communication skills. Vital Talk and the Serious Illness Care Program are formal training programs of four days and a half-day in length, respectively, for improving providers’ communication skills. The Best Case/Worst Case tool is a decision aid developed by surgeons for surgeons guiding patients through difficult choices. Published frameworks such as SPIKES and ABCDE outline key steps to navigate challenging conversations and break bad news. Numerous factors contribute to quality of communication, including setting, positioning of participants, open-ended questions, clear and concise language, responding to emotion, and engaging in shared decision-making.

Summary

We describe a strategy for difficult conversations that is tailored for use by surgeons and modeled on surgical principles.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mast MS, Kindlimann A, Langewitz W. Recipients’ perspective on breaking bad news: How you put it really makes a difference. Patient Educ Couns. 2005;58(3):244–51.

    Article  Google Scholar 

  2. ∙ Arnold RM, Back AL, Baile WF, Edwards KA, Tulsky JA. The oncotalk/vitaltalk model. Oxford Textbook of Communication in Oncology and Palliative Care. 2017:363. VitalTalk (formerly OncoTalk) is a training program with multi-day workshops, online videos, and a smartphone app that guide providers in developing communication skills.

  3. ∙ Bernacki R, Hutchings M, Vick J, Smith G, Paladino J, Lipsitz S et al. Development of the Serious Illness Care Program: a randomised controlled trial of a palliative care communication intervention. BMJ Open. 2015;5(10):e009032. The Serious Illness Care Program provides a half-day training course and a concise pocket guide for serious illness communication.

  4. Bernacki R, Paladino J, Neville BA, Hutchings M, Kavanagh J, Geerse OP, et al. Effect of the serious illness care program in outpatient oncology: a cluster randomized clinical trial. JAMA Intern Med. 2019;179(6):751–9.

    Article  Google Scholar 

  5. ∙∙ Taylor LJ, Nabozny MJ, Steffens NM, Tucholka JL, Brasel KJ, Johnson SK et al. A framework to improve surgeon communication in high-stakes surgical decisions: best case/worst case. JAMA Surg. 2017;152(6):531–8. The best case/worst case decision aid is an essential tool made for surgeons by surgeons, outlining a shared approach to making a difficult, complex medical decision based on the patient's values.

  6. ∙∙ Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302–11. The SPIKES framework prompts the surgeon to attend to important steps of communication: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary.

  7. ∙∙ Rabow MW, Mcphee SJ. Beyond breaking bad news: how to help patients who suffer. West J Med. 1999;171(4):260. The ABCDE framework prompts these key steps of communication: Advance preparation, Build a therapeutic environment/relationship, Communicate well, Deal with patient and family reactions, Encourage and validate emotions.

  8. Friedrichsen MJ, Strang PM. Doctors' strategies when breaking bad news to terminally ill patients. J Palliat Med. 2003;6(4):565–74.

    Article  Google Scholar 

  9. Monden KR, Gentry L, Cox TR, editors. Delivering bad news to patients. Baylor University Medical Center Proceedings; 2016: Taylor & Francis.

  10. Gay EB, Pronovost PJ, Bassett RD, Nelson JE. The intensive care unit family meeting: making it happen. J Crit Care. 2009;24(4):629. e1-. e12.

  11. Weissman DE, Quill TE, Arnold RM. Preparing for the family meeting #222. J Palliat Med. 2010;13(2):203–4.

    Article  Google Scholar 

  12. Tan HM, Wilson A, Olver I, Barton C. The experience of palliative patients and their families of a family meeting utilised as an instrument for spiritual and psychosocial care: A qualitative study. BMC Palliat Care. 2011;10(1):7.

    Article  Google Scholar 

  13. Basu G, Costa VP, Jain P. Clinicians’ obligations to use qualified medical interpreters when caring for patients with limited English proficiency. AMA J Ethics. 2017;19(3):245–52.

    Article  Google Scholar 

  14. Norris WM, Wenrich MD, Nielsen EL, Treece PD, Jackson JC, Curtis JR. Communication about end-of-life care between language-discordant patients and clinicians: insights from medical interpreters. J Palliat Med. 2005;8(5):1016–24.

    Article  Google Scholar 

  15. Bruera E, Palmer JL, Pace E, Zhang K, Willey J, Strasser F, et al. A randomized, controlled trial of physician postures when breaking bad news to cancer patients. Palliat Med. 2007;21(6):501–5.

    Article  Google Scholar 

  16. Weissman DE, Quill TE, Arnold RM. The family meeting: starting the conversation #223. J Palliat Med. 2010;13(2):204–5.

    Article  Google Scholar 

  17. Smith RC, Hoppe RB. The patient's story: integrating the patient-and physician-centered approaches to interviewing. Ann Intern Med. 1991;115(6):470–7.

    Article  CAS  Google Scholar 

  18. Rawlings D, Tieman JJ, Sanderson C, Parker D, Miller-Lewis L. Never say die: death euphemisms, misunderstandings and their implications for practice. Int J Palliat Nurs. 2017;23(7):324–30.

    Article  Google Scholar 

  19. Buckman RA. Breaking bad news: the SPIKES strategy. Community Oncol. 2005;2(2):138–42.

    Article  Google Scholar 

  20. Morse JM. Responding to the cues of suffering. Health Care Women Int. 2000;21(1):1–9.

    Article  CAS  Google Scholar 

  21. Back AL, Arnold RM. “Isn't there anything more you can do?”: when empathic statements work, and when they don't. J Palliat Med. 2013;16(11):1429–32.

    Article  Google Scholar 

  22. Munoz Sastre MT, Sorum PC, Mullet E. Breaking bad news: the patient's viewpoint. Health Commun. 2011;26(7):649–55.

    Article  Google Scholar 

  23. Barry MJ, Edgman-Levitan S. Shared decision making—The pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1.

    Article  CAS  Google Scholar 

  24. Weissman DE, Quill TE, Arnold RM. The family meeting: end-of-life goal setting and future planning #227. J Palliat Med. 2010;13(4):462–3.

    Article  Google Scholar 

  25. Kruser JM, Nabozny MJ, Steffens NM, Brasel KJ, Campbell TC, Gaines ME, et al. “Best Case/Worst Case”: Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions. J Am Geriatr Soc. 2015;63(9):1805–11.

    Article  Google Scholar 

  26. Lakin JR, Block SD, Billings JA, Koritsanszky LA, Cunningham R, Wichmann L, et al. Improving communication about serious illness in primary care: a review. JAMA Intern Med. 2016;176(9):1380–7.

    Article  Google Scholar 

  27. Luff D, Martin EB Jr, Mills K, Mazzola NM, Bell SK, Meyer EC. Clinicians’ strategies for managing their emotions during difficult healthcare conversations. Patient Educ Couns. 2016;99(9):1461–6.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Joseph A. Lin & Allyson C. Cook

  2. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Joseph A. Lin

Authors
  1. Joseph A. Lin
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  2. Allyson C. Cook
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Correspondence to Joseph A. Lin.

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This article is part of the Topical collection on Surgical Education.

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Lin, J.A., Cook, A.C. A Surgeon’s Review for Difficult Conversations. Curr Surg Rep 8, 2 (2020). https://doi.org/10.1007/s40137-020-00247-5

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  • DOI: https://doi.org/10.1007/s40137-020-00247-5

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