After being present during preoperative visits for two surgeries that her father recently underwent, Sarina Isenberg, PhD, began wondering what effect she was having on the conversation.

Isenberg, currently a scientist at the Temmy Latner Centre for Palliative Care in Toronto, made this the focus of her dissertation. Researchers analyzed 46 visits in which companions were present, and 15 in which companions were absent.1

“I was intrigued by whether there may be fundamental differences between patients that are and are not accompanied, and whether having a family member present in the visit might impact the nature of the conversation that occurs between the patient and surgeon during the preoperative visit,” says Isenberg.

Companions’ presence during pre-surgical visits was associated with patient-surgeon communication. However, there was no difference in patient or surgeon satisfaction.

Previous research demonstrated various ways in which family companions affect the nature of the conversation during routine medical visits.2 “I wanted to test whether their findings might be translatable to the preoperative setting,” says Isenberg.

Researchers expected that the visit would be more patient-centered due to companions acting as patient advocates. They found the opposite was true: Companions’ presence was associated with lower levels of patient-centeredness.

“This change was largely driven by the companion asking biomedical questions, the surgeon providing more biomedical information, and the patient disclosing less lifestyle and psychosocial information,” says Isenberg.

Given the study’s small sample size, Isenberg is hesitant to draw ethical implications. “Our results suggested that companions altered the nature of communication. However, we cannot ascertain whether this change is ethically good or bad,” she says.

At first glance, one might intuit that companions should not be present during the preoperative exchange, since it results in a less patient-centered conversation. “However, the companions’ presence might very well be beneficial to the patient,” says Isenberg.

Companions might perceive patients as too anxious to effectively participate in the visit. “Consequently, companions may feel compelled to advocate for the patient by asking technical questions about the surgery, thereby providing informational social support,” suggests Isenberg.

Similarly, surgeons may refrain from providing too much technical information to unaccompanied patients to avoid overwhelming them. “Conversely, the presence of a companion may prompt the surgeon to provide information that the companion can document or remember for the patient,” says Isenberg.

Companions have another important reason for wanting technical information. They’re often tasked with caring for the patient at home post-surgery, which requires wound management, medication administration, and symptom monitoring. “This may lead them to have more informational needs during the preoperative visit,” says Isenberg.

REFERENCES

1. Isenberg SR, Aslakson RA, Dionne-Odom JN, et al. Family companions’ involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction. Patient Educ Couns 2018; 101(6):1066-1074.

2. Wolff JL, Roter DL. Family presence in routine medical visits: A meta-analytical review. Social Science and Medicine 2011; 72:823-831.

SOURCE

• Sarina Isenberg, PhD, Scientist, Temmy Latner Centre for Palliative Care/Assistant Professor, Department of Family and Community Medicine, University of Toronto. Email: sarina.isenberg@sinaihealthsystem.ca.