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Surgeons need better communication skills for high-stakes cardiothoracic surgery. Improving shared decision-making and patient engagement before and after surgery is crucial for goal-concordant care.

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Area of Science:

  • Medical Ethics
  • Surgical Communication
  • Patient-Centered Care

Background:

  • Cardiothoracic surgery involves high-stakes, rapid decisions, often with limited prior patient relationships.
  • Effective communication is vital for informed consent and navigating complex postoperative scenarios.

Purpose of the Study:

  • To review challenges in preoperative and postoperative decision-making and communication in cardiothoracic surgery.
  • To explore shared decision-making as the preferred method for informed consent.
  • To provide strategies for optimizing surgeon communication and patient/family engagement.

Main Methods:

  • Literature review of ethical and legal requirements for informed consent.
  • Analysis of decision-making challenges in high-risk surgery for older patients with serious illness.
  • Exploration of concepts like clinical heroism and futility in surgical outcomes communication.

Main Results:

  • Shared decision-making is the contemporary standard for informed consent.
  • Postoperative decisions often involve surrogate decision-makers when patients lose capacity.
  • Effective communication strategies are needed to address patient discontent and ensure goal-concordant care.

Conclusions:

  • Surgeons must enhance communication skills to improve patient and family engagement.
  • Addressing ethical challenges in perioperative decision-making is essential for optimal patient care.
  • Frameworks for communication can support high-risk surgical scenarios, especially for vulnerable populations.