Patient-centered communication in cosmetic eyelid surgery consultations in China: an observational transcript-based...

Elective cosmetic procedures are preference-sensitive encounters in which satisfaction depends on aligning clinically feasible options with patient's aesthetic goals and expectations. Yet, in high-throughput outpatient services, the extent to which patient-centered communication is operationalized in real consultations remains under-documented.

We conducted an observational, transcript-based mixed qualitative and descriptive-quantitative study of 50 audio-recorded consultations for double-eyelid blepharoplasty and medial epicanthoplasty at a tertiary oculoplastics center in Shanghai, China. Consultations were transcribed verbatim, and doctors' talk was segmented into minimal intonation units and coded to the E5 framework (Engage, Educate, Empathize, Enable, Enlist). We used thematic qualitative analysis and descriptive quantitative summaries of speaking-time distribution and strategy-specific time to characterize how communication functions were distributed and enacted in routine service delivery.

Conversations averaged 10.8 min; doctors accounted for 85% of speaking time. Educational talk dominated doctor's E5-coded time (66.6%), driven primarily by step-by-step procedural explanations and brief visual demonstrations. In contrast, relational and participatory strategies were rare: Engage≈1.5% of E5 time, Empathize 3.6% (combined), and Enlist 1.7%. Preference negotiating and expectation-setting were consistently shorter than procedural explanation, indicating limited interactional space for patients to articulate goals, anxieties, or social motivations.

In this high-volume tertiary public oculoplastic service in Shanghai, consultations were strongly information-delivery-oriented but minimally participatory, with clinician talk effectively setting the aesthetic agenda. To better align practice with patient-centered care and shared decision-making, services should streamline repetitive explanations (e.g., via reusable visual/digital materials) and protect brief, observable elicitation and enlistment moments within the visit so that patient values can actively shape the surgical plan.