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Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807757
Review Article

Beyond “Bleeding, Infection, Damage to Surrounding Structures”: Challenges and Opportunities When Communicating about Surgical Risks

Melanie L. Fritz
1   Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Ana C. De Roo
1   Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
› Author Affiliations Funding The project described was supported by the National Cancer Institute of the National Institutes of Health (NIH) under Award T32CA090217. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Abstract

Informed consent and shared decision-making are central tenets of surgical consultations and the decision to proceed, or not, with surgery. These standard practices require communication with patients about the risks and benefits of the procedures they are considering. Yet communicating about risk is not straightforward. Limited health literacy, cognitive pitfalls, and the emotional experience of illness or a new diagnosis can all impact how patients interpret the information they receive. Beyond the legal obligations to ensure patients are informed, communicating effectively about risk can also support patients throughout the perioperative period, particularly if rare complications occur. We propose a framework for discussing risks and downsides of surgery that contextualizes rare risks in the expected trajectory of recovery, supporting patients through the decision-making process and onwards.

Keywords

shared decision-making - communication - informed consent - prognostication


Publication History

Article published online:
24 April 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Cocanour CS. Informed consent-It's more than a signature on a piece of paper. Am J Surg 2017; 214 (06) 993-997
    PubMedSearch in Google Scholar
  • 2 Leclercq WKG, Keulers BJ, Scheltinga MRM, Spauwen PHM, van der Wilt GJ. A review of surgical informed consent: past, present, and future. A quest to help patients make better decisions. World J Surg 2010; 34 (07) 1406-1415
    PubMedSearch in Google Scholar
  • 3 Elwyn G, Durand MA, Song J. et al. A three-talk model for shared decision making: multistage consultation process. BMJ 2017; 359: j4891
    CrossrefPubMedSearch in Google Scholar
  • 4 Elwyn G. Shared decision making: What is the work?. Patient Educ Couns 2021; 104 (07) 1591-1595
    CrossrefPubMedSearch in Google Scholar
  • 5 Cohen ME, Ko CY, Bilimoria KY. et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 2013; 217 (02) 336-46.e1
    CrossrefPubMedSearch in Google Scholar
  • 6 Hornor MA, Ma M, Zhou L. et al. Enhancing the American College of Surgeons NSQIP surgical risk calculator to predict geriatric outcomes. J Am Coll Surg 2020; 230 (01) 88-100.e1
    CrossrefPubMedSearch in Google Scholar
  • 7 Liu Y, Cohen ME, Hall BL, Ko CY, Bilimoria KY. Evaluation and enhancement of calibration in the American College of Surgeons NSQIP Surgical Risk Calculator. J Am Coll Surg 2016; 223 (02) 231-239
    PubMedSearch in Google Scholar
  • 8 Sherman SK, Poli EC, Kapadia MR, Turaga KK. Estimating surgical risk for patients with severe comorbidities. JAMA Surg 2018; 153 (08) 778-780
    PubMedSearch in Google Scholar
  • 9 Ziegler MA, Bauman JC, Welsh RJ, Wasvary HJ. Can the American College of Surgeons National Surgical Quality Improvement Program Risk calculator predict outcomes for urgent colectomies?. Am Surg 2022; 88 (01) 65-69
    PubMedSearch in Google Scholar
  • 10 Gabay G, Bokek-Cohen Y. What do patients want? Surgical informed-consent and patient-centered care - An augmented model of information disclosure. Bioethics 2020; 34 (05) 467-477
    PubMedSearch in Google Scholar
  • 11 Shinkunas LA, Klipowicz CJ, Carlisle EM. Shared decision making in surgery: a scoping review of patient and surgeon preferences. BMC Med Inform Decis Mak 2020; 20 (01) 190
    PubMedSearch in Google Scholar
  • 12 Stalter LN, Baggett ND, Hanlon BM. et al. Identifying patterns in preoperative communication about high-risk surgical intervention: a secondary analysis of a randomized clinical trial. Med Decis Making 2023; 43 (04) 487-497
    PubMedSearch in Google Scholar
  • 13 El-Wakeel H, Taylor GJ, Tate JJ. What do patients really want to know in an informed consent procedure? A questionnaire-based survey of patients in the Bath area, UK. J Med Ethics 2006; 32 (10) 612-616
    PubMedSearch in Google Scholar
  • 14 McManus PL, Wheatley KE. Consent and complications: risk disclosure varies widely between individual surgeons. Ann R Coll Surg Engl 2003; 85 (02) 79-82
    PubMedSearch in Google Scholar
  • 15 Chen AM, Leff DR, Simpson J, Chadwick SJ, McDonald PJ. Variations in consenting practice for laparoscopic cholecystectomy. Ann R Coll Surg Engl 2006; 88 (05) 482-485
    PubMedSearch in Google Scholar
  • 16 Kang R, Saunders CH, Carpenter-Song EA. et al. A mixed-methods evaluation of patient education materials for colorectal cancer. Dis Colon Rectum 2021; 64 (10) 1249-1258
    PubMedSearch in Google Scholar
  • 17 Castro CM, Wilson C, Wang F, Schillinger D. Babel babble: physicians' use of unclarified medical jargon with patients. Am J Health Behav 2007; 31 (Suppl. 01) S85-S95
    PubMedSearch in Google Scholar
  • 18 Hayter RR, Hess AS. Health numeracy and relative risk comprehension in perioperative patients and physicians. Anesth Analg 2020; 131 (02) 579-585
    PubMedSearch in Google Scholar
  • 19 Theiss LM, Wood T, McLeod MC. et al. The association of health literacy and postoperative complications after colorectal surgery: A cohort study. Am J Surg 2022; 223 (06) 1047-1052
    CrossrefPubMedSearch in Google Scholar
  • 20 Gigerenzer G. The psychology of good judgment: frequency formats and simple algorithms. Med Decis Making 1996; 16 (03) 273-280
    PubMedSearch in Google Scholar
  • 21 Epstein RM, Alper BS, Quill TE. Communicating evidence for participatory decision making. JAMA 2004; 291 (19) 2359-2366
    PubMedSearch in Google Scholar
  • 22 Witzel K, Koch HJ, Kaminski C. Impact of Medical TV shows on preprocedural fear of surgical in-house patients. Eur Surg Res 2017; 58 (3-4): 121-127 . Accessed August 21, 2024 at: https://karger.com/esr/article-abstract/58/3-4/121/128472/Impact-of-Medical-TV-Shows-on-Preprocedural-Fear
    PubMedSearch in Google Scholar
  • 23 Lloyd AJ. The extent of patients' understanding of the risk of treatments. Qual Health Care 2001; 10 (Suppl. 01) i14-i18
    PubMedSearch in Google Scholar
  • 24 Uzbeck M, Quinn C, Saleem I, Cotter P, Gilmartin JJ, O'Keeffe ST. Randomised controlled trial of the effect of standard and detailed risk disclosure prior to bronchoscopy on peri-procedure anxiety and satisfaction. Thorax 2009; 64 (03) 224-227
    PubMedSearch in Google Scholar
  • 25 Mazzocco K, Masiero M, Carriero MC, Pravettoni G. The role of emotions in cancer patients' decision-making. Ecancermedicalscience 2019; 13: 914
    PubMedSearch in Google Scholar
  • 26 Fagerlin A, Zikmund-Fisher BJ, Ubel PA. Helping patients decide: ten steps to better risk communication. J Natl Cancer Inst 2011; 103 (19) 1436-1443
    CrossrefPubMedSearch in Google Scholar
  • 27 Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Risky feelings: why a 6% risk of cancer does not always feel like 6%. Patient Educ Couns 2010; 81 (suppl): S87-S93
    PubMedSearch in Google Scholar
  • 28 Saunders CH, Goldwag JL, Read JT, Durand MA, Elwyn G, Ivatury SJ. ‘Because Everybody is so Different’: a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021; 11 (05) e043245
    CrossrefPubMedSearch in Google Scholar
  • 29 Reinwalds M, Blixter A, Carlsson E. Living with a resected rectum after rectal cancer surgery-Struggling not to let bowel function control life. J Clin Nurs 2018; 27 (3-4): e623-e634
    PubMedSearch in Google Scholar
  • 30 Hirpara DH, Cleghorn MC, Sockalingam S, Quereshy FA. Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery. Can J Surg 2016; 59 (03) 197-204
    PubMedSearch in Google Scholar
  • 31 Davis DS. No surprises, please!. Narrat Inq Bioeth 2013; 3 (01) 8-10
    PubMedSearch in Google Scholar
  • 32 Zaza SI, Arnold RM, Schwarze ML. Innovations in surgical communication 4-present the downsides of surgery, not just risks. JAMA Surg 2023; 158 (10) 998-1000
    PubMedSearch in Google Scholar
  • 33 Schwarze ML, Arnold RM, Clapp JT, Kruser JM. Better Conversations for better informed consent: talking with surgical patients. Hastings Cent Rep 2024; 54 (03) 11-14
    PubMedSearch in Google Scholar
  • 34 Schwarze ML, Kruser JM, Clapp JT. Innovations in surgical communication 2-focus on the goals of surgery. JAMA Surg 2023; 158 (10) 994-996
    PubMedSearch in Google Scholar