Patient-Centered Care in Surgery: How Best to Communicate with Families

uvmmedicine blogger Lindsay Howe '19
uvmmedicine blogger Lindsay Howe ’19

This is the fourth in a series of blog posts written by UVM College of Medicine 2016 Summer Research Fellows.

During my first year at the University of Vermont College of Medicine, I shadowed physicians as much as a schedule filled with lectures, labs and studies allowed.  The opportunity to leave the classroom to interact with patients, families and medical professionals gave me an extra boost of energy and enthusiasm to complete each demanding week. I decided that I wanted to spend this summer conducting clinical research in the hospital, as it would be the only summer of medical school that would not involve demanding rotations. So I approached one of the surgeons about possible research opportunities during a shadowing experience in the Department of Orthopaedics.  Within a few days, Dr. Blankstein and I constructed a summer project that incorporated two areas that we are both very enthusiastic about: orthopaedic surgery and patient-centered care.

As the emphasis on patient and family-centered care grows, medical professionals are determined to improve the quality of care for the patient, as well as the patient’s family.  Research has shown that perioperative communication is important in reducing family member anxiety. It also improves the overall experience of family members waiting for surgical patients.  Presently, there is no agreed upon standardized time frame to deliver intra- and post-operative information to patients’ families. Some surgeons prefer to deliver news and information before a procedure is entirely complete. Dr. Blankstein and I, along with seven orthopaedic surgeons at the UVM Medical Center, are focused on determining the effect of strategic communication with patients’ families during the perioperative period on the families’ satisfactions, anxiety levels and overall experience.  We hypothesize that the greatest patient and family satisfaction would come from receiving critical strategic updates at vital  moments during the surgical procedure.

I’ve been very involved in many aspects of the study: Every morning, I randomized the placement of the surgeons’ patients involved in the study, putting them in either the control group or the intervention group.  In the control pathway, communication was delivered to the family members in a standard fashion. Currently, families receive information when a patient enters and leaves the operating room. Surgeons then communicate with the family within a short period after procedure completion. In the intervention group, the families received additional standardized electronic updates via pagers at pivotal moments during the surgery and recovery period. Once all the patients were randomized, I went to the pre-op area to speak with the patient and their families about my study. If they agreed to participate, I administered a survey to the family after the post-surgical surgeon consultation. The data from this study will allow us to evaluate whether satisfaction and anxiety may be reduced with timely updates, which may help to improve patient and family satisfaction in the perioperative period.

My experience this summer has been a change from my life as a medical student. During the school year, I know the exact organization of each day. I can often plan my study strategies for the entire week before the weekend is over. Research offered me a new routine. I started each day with the possibility of meeting new patients with many different health issues or concerns, and I had much less control over the pace and quantity of work that got  done.  This could be frustrating at times, but it has helped me to problem solve in a clinical setting. Obtaining IRB project approval alone proved to be a challenging yet rewarding project. Listening to the patients and families’ perspectives about the hospital environment and surgical experience has provided me a better understanding and awareness that will enrich my preparation to become a better physician.

During the first year, I received advice from a number of medical students, professors and physicians regarding plans for my last rotation free summer. This included advice ranging from “research is mandatory from a residency standpoint,” to “have fun, enjoy yourself and travel.” I felt the best advice was to do something that was meaningful to me, enjoyable and provided an experience that would help me with my future medical goals. For me, this was the opportunity to spend eight weeks in the hospital, interacting with patients, their families and the OR while conducting a study that will hopefully provide some valuable feedback for future patients and families. For other students, it might be bench research, traveling on a Global Health project, or backpacking throughout Europe. As we begin our second year of medical school, we will all draw from our summer experiences as we continue to strive to be strong medical students and the best version of ourselves.

What are your thoughts about this topic?