Little words BIG impact: Perioperative communication for children with burns

Abstract

Anaesthetists are key members of teams caring for burn-injured children in almost every aspect of their management. Their role can involve initial resuscitation, intensive care, analgesia, and anaesthesia for multiple procedures both acutely and subsequently for scar management. As key members of burns management teams, effective communication with patients and their families as well as other members of the burn care team is vital. There is little guidance, however, addressing how the anaesthetist might communicate and optimise anaesthetic burns care of children pre-, intra-, and postoperatively. Advances in the understanding of the neurobiology of communication suggests that we need to consider positive (placebo) or negative (nocebo) subconscious processes. Learnable language structures GREAT (Greeting, Rapport, Expectations, Addressing concerns, Tacit agreement) and LAURS (Listening, Acceptance, Utilisation, Reframing, Suggestion) can facilitate any patient or family interaction ensuring children and their parents feel they are being heard and understood. Talking about finishing rather than starting when about to perform a potentially painful procedure can also facilitate burns care with children. Other strategies include the avoidance of nocebo communications or apologising before a painful procedure and, instead, focusing on therapeutic (placebo) alternatives. Children do not view pain in the same way as adults do, and techniques such as play therapy and hypnosis can be valuable adjuncts to traditional analgesia administration in burns care, with the added benefit of minimising side-effects. The use of regular time-outs during prolonged burns surgeries is a helpful communication strategy between the anaesthetist and other members of the burns team that can optimise patient safety. Communication is a core clinical skill in the practice of anaesthesia during paediatric burns care and is an area for future research.

Please mind your language!

“…The use of such language increases perioperative anxiety and pain. 3,4,6,7 Neutral phrases and open-ended statements are an alternative to nocebo language. 3,5,6 The following are some examples of nociceptive phrases (in italics) and possible alternatives:…”

“…The use of these techniques by medical professionals has been shown to reduce anxiety, premedication use, postoperative pain, constipation and improve recovery time and appetite. 2,3,7,8 As patients' openness to suggestion (and susceptibility to nocebo language) increases when highly anxious, distressed, in pain or pregnant, 8,9 the anaesthetist perioperative visit seems an optimal time to maximise these beneficial techniques.…”

“…Research dating back to the 1960s has shown that good communication during the patient-anaesthetist interaction reduces anxiety, stress, postoperative analgesia requirements, length of stay and improves patient satisfaction. [1][2][3] There is a variety of specific language techniques (Table 1) which research suggests can benefit or harm patients, [4][5][6][7] many were mentioned in a recent article by Cyna in this journal. 3 We conducted an observational audit to assess the frequency with which senior anaesthetists used specific language techniques including rapport building (e.g.…”

“…[1][2][3] There is a variety of specific language techniques (Table 1) which research suggests can benefit or harm patients, [4][5][6][7] many were mentioned in a recent article by Cyna in this journal. 3 We conducted an observational audit to assess the frequency with which senior anaesthetists used specific language techniques including rapport building (e.g. discussing personal topics, attentive listening, reflective listening), nocebo language, positive suggestion and simple relaxation techniques (e.g.…”

A review series on the management of burns injury

“…The current theme issue begins with a historical cover note on burns resuscitation 3 and then includes two articles on recent developments in surgical burns management, 4,5 a detailed review of the techniques and challenges involved in anaesthesia and pain management of burn-injured patients, 6 another on the intensive care management of patients with inhalational injuries 7 and finally a paper on the particular challenges of effective communication during the care of younger patients with burns. 8 The information contained in these articles is up to date and has already been translated into the clinical setting, with dramatic improvement in outcomes for patients with extensive burns that was not imaginable a decade ago.…”