The effect of complications on the patient-surgeon relationship after colorectal cancer surgery

Abstract

Background Trust in physicians is an essential part of therapeutic relationships. Complications are common after colorectal cancer procedures, but little is known of their effect on patient-surgeon relationships. We hypothesized that unexpected complications impair trust and communication between patients and surgeons. Methods We performed a population-based survey of surgically diagnosed stage III colorectal cancer patients in the Surveillance Epidemiology and End Results registries for Georgia and Metropolitan Detroit between August 2011 and October 2012. Using published survey instruments, we queried subjects about trust in and communication with their surgeon. The primary predictor was the occurrence of an operative complication. We examined patient factors associated with trust and communication then compared the relationship between operative complications and patient-reported trust and communication with their surgeons. Results Among 622 preliminary respondents (54% response rate), 25% experienced postoperative complications. Those with complications were less likely to report high trust (73% vs 81%, P = .04) and high-quality communication (80% vs 95%, P < .001). Complications reduced trust among only 4% of patient-surgeon dyads with high-quality communication, whereas complications diminished patients’ trust in 50% with poorer communication (P < .001). After controlling for communication ratings, we found there was no residual effect of complications on trust (P = .96). Conclusion Most respondents described trust in and communication with their surgeons as high. Complications were common and were associated with lower trust and poorer communication. However, the relationship between complications and trust was modified by communication. Trust remained high, even in the presence of complications, among respondents who reported high levels of patient-centered communication with their surgeons.

The personal financial burden of complications after colorectal cancer surgery

“…Worry was evaluated on a 5-point Likert scale that we dichotomized in accordance with our previous work (in which scores of 1-3 were considered low, and scores of 4-5 were considered high). 19 The results from this assessment of internal consistency of the financial burden composite score are presented below.…”

A Composite Measure of Personal Financial Burden Among Patients With Stage III Colorectal Cancer

“…The composite measure was internally validated against a binary item on global financial burden (My illness has had no impact on my finances) and a single question about financial worry (How much do you worry about financial problems that have resulted from your colorectal cancer and its treatment). In accordance with our previous work, 15 worry was measured using a Likert scale that we dichotomized into “low” and “high” (Table 1). …”

Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment

“…9 Failure to communicate and manage this complication adequately will engender greater patient mistrust and dissatisfaction, leading to both increased complaints and litigation. 10 It is also important to recognize that laryngeal dysfunction is more complex than just VFP. Laryngeal dysfunction encompasses sensory and motor dysfunction that can lead to symptoms of cough, globus sensation, and dysphagia.…”