Differences in Assessing Surrogate Understanding of the Patient's Clinical Situation

Area of Science:

• Medical Communication
• Clinical Decision-Making
• Patient-Surrogate Interaction

Background:

• Assessing surrogate understanding is crucial for effective shared decision-making and communication skills training.
• Current best practices for assessing surrogate understanding in clinical settings remain unclear.
• Surrogate comprehension and perspective-sharing are vital for patient care.

Purpose of the Study:

• To identify the types of questions clinicians use to gauge surrogate understanding of a patient's clinical status.
• To analyze how surrogates respond to different clinician questioning strategies.
• To inform communication skills training for clinicians interacting with surrogates.

Main Methods:

• Qualitative analysis of 27 audio-recorded clinician-surrogate conversations using conversation analysis.
• Focus on 10 conversations where clinicians explicitly asked about surrogate understanding.
• Examination of response patterns to various clinician questions.

Main Results:

• Different clinician questions yielded distinct surrogate responses regarding patient understanding.
• Questions like "what have you heard" prompted recall of statements and assessments.
• Questions like "what is going on" or "what do you understand" elicited a broader, "big-picture" comprehension from surrogates.

Conclusions:

• The phrasing of clinician questions significantly influences the depth and type of surrogate understanding shared.
• Specific questioning strategies can lead to more comprehensive surrogate insights.
• Further research is needed on the real-world implications and surrogate perspectives of these communication strategies for training development.