ArticleAnnals of surgery2014
It's big surgery: preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations.
Article in Annals of surgery, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Anesthesiologist to Patient Communication: A Systematic Review.JAMA network open · 2020Pooled it
- Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial.JAMA network open · 2023Trial
- A Multicenter, Randomized Controlled Trial of Perioperative Palliative Care Surrounding Cancer Surgery for Patients and Their Family Members (PERIOP-PC).Journal of palliative medicine · 2019Trial
- Trial
- Trial
- Patient Perceptions of Palliative Care in Surgery: A Qualitative Study.Journal of pain and symptom management · 2026Article
- Predicting Protracted Recovery and Long-Term Loss of Independence after Major Surgery in Veterans.Annals of surgery · 2026Article
- A Scoping Review on Goals of Care Discussions in Surgery: How Are We Doing and How Can We Do Better?World journal of surgery · 2025Article
- Top Ten Tips Palliative Care Clinicians Should Know Before Their Patient Undergoes Surgery.Journal of palliative medicine · 2025Article
- Racial disparities in end-of-life suffering within surgical intensive care units.Trauma surgery & acute care open · 2024Article
- Evaluation of a Novel Question Prompt List in Pediatric Surgical Oncology.The Journal of surgical research · 2023Article
- Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study.British journal of anaesthesia · 2023Article
- "Reading the room:" A qualitative analysis of pediatric surgeons' approach to clinical counseling.Journal of pediatric surgery · 2023Article
- Surgical Informed Consent: A Scoping Review of Physician-facing Decision Support Tools.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2023Article
- A valued voice: A qualitative analysis of parental decision-making preferences in emergent paediatric surgery.Health expectations : an international journal of public participation in health care and health policy · 2023Article
- Visual Preoperative Risk Depiction Tools for Shared Decision-making: A Pilot Study from the Surgeon's Perspective.Plastic and reconstructive surgery. Global open · 2022Article
- Shame as a moral mood in medicine.Journal of evaluation in clinical practice · 2022Article
- Physicians' perspectives of prognosis and goals of care discussions after hip fracture.Journal of the American Geriatrics Society · 2022Article
- Ethics Consultation in Surgical Specialties.HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues · 2022Article
- Incorporating palliative care principles to improve patient care and quality of life in urologic oncology.Nature reviews. Urology · 2021Review
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectiveTo identify the processes, surgeons use to establish patient buy-in to postoperative treatments.
backgroundSurgeons generally believe they confirm the patient's commitment to an operation and all ensuing postoperative care, before surgery. How surgeons get buy-in and whether patients participate in this agreement is unknown.
methodsWe used purposive sampling to identify 3 surgeons from different subspecialties who routinely perform high-risk operations at each of 3 distinct medical centers (Toronto, Ontario; Boston, Massachusetts; Madison, Wisconsin). We recorded preoperative conversations with 3 to 7 patients facing high-risk surgery with each surgeon (n = 48) and used content analysis to analyze each preoperative conversation inductively.
resultsSurgeons conveyed the gravity of high-risk operations to patients by emphasizing the operation is "big surgery" and that a decision to proceed invoked a serious commitment for both the surgeon and the patient. Surgeons were frank about the potential for serious complications and the need for intensive care. They rarely discussed the use of prolonged life-supporting treatment, and patients' questions were primarily confined to logistic or technical concerns. Surgeons regularly proceeded through the conversation in a manner that suggested they believed buy-in was achieved, but this agreement was rarely forged explicitly.
conclusionsSurgeons who perform high-risk operations communicate the risks of surgery and express their commitment to the patient's survival. However, they rarely discuss prolonged life-supporting treatments explicitly and patients do not discuss their preferences. It is not possible to determine patients' desires for prolonged postoperative life support on the basis of these preoperative conversations alone.
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