Department of Surgery, University of Wisconsin, Madison, WI, USA.
Department of Surgery, Georgetown University Hospital, Washington D.C, USA.
Am J Surg. 2021 Oct;222(4):670-676. doi: 10.1016/j.amjsurg.2021.06.004. Epub 2021 Jun 15.
After serious postoperative complications, patients and families may experience conflict about goals of care.
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.
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.
Postoperative conflict following serious complications is well described but its incidence may be low. Nonetheless, patient and family observations reveal opportunities for improvement.
在发生严重术后并发症后，患者及其家属可能会在医疗照护目标上产生冲突。
我们开展了一项多中心随机临床试验，以测试问题提示清单对术后冲突的影响。我们对年龄≥60 岁且经历严重并发症的患者及其家属进行了访谈。我们采用定性内容分析法对冲突进行分析，并对患者的并发症体验进行了特征描述。
446 例患者中有 56 例发生了严重并发症。患者通常不报告与术后治疗相关的冲突，并对他们所接受的治疗表示支持。我们未观察到干预组与常规护理组之间的冲突存在差异。受访者报告感到对并发症毫无准备，目睹了团队成员之间激烈的互动，以及在术前对他们的外科医生缺乏信任。
严重并发症后的术后冲突描述得很好，但其发生率可能较低。尽管如此，患者和家属的观察结果还是揭示了一些改进的机会。
