Evaluation and improvement of doctor–patient communication competence for emergency neurosurgeons: a standardized family model

Figures & data

Table 1 Integrity of the communication content with SAH patients’ families

Encounter	Undone (0–2 scores)	Insuff	Done (0–2 scores)
1. Introducing physician himself
2. Inform family members that the patient is in a critical situation and an emergency operation may be needed
Delivery of bad news and information of patient’s condition (3–8)
3. Possible diagnosis
4. Relationship between pathophysiologic procedures, symptoms, and outcomes
5. Briefly explain the Hunt-Hess scale and the relationship with outcomes
6. Prediction of mortality and morbidity rates according to the diagnosis and patient’s situation
7. Prediction of outcome and neurofunctions according to the diagnosis and patient’s situation
8. Possible improvement or deterioration at any time
Introducing risk factors associated with SAH (9–18)
9. Aneurysms rebleeding
10. Cerebral vasospasm
11. Hydrocephalus associated with SAH
12. Seizures associated with SAH
13. Hyponatremia or electrolyte imbalance
14. Aspiration pneumonia
15. Arrhythmia, myocardial infarction, and heart failure
16. Decubital ulcer and phlebothrombosis
17. Cushing’s ulcer
18. Other complications associated with SAH and unpredictable events
Informed consent and treatment options (19–28)
19. Necessity and purpose of emergency operation
20. Outcomes associated with operation options
21. Define modus operandi with neurosurgeon’s help
22. Introduce main operative procedures
23. Introduce the operator
24. Express neurosurgeon’s endeavor
25. Notify the rates and complications associated with anesthesia
26. Medicine, which is science other than witchcraft, cannot cure all diseases
27. Briefly introduce the postoperative treatment
28. Cost
Possible complications and rates associated with operation (29–34)
29. Complications associated with placement of femoral artery catheter
30. Complications associated with catheter cerebral angiography
31. Complications associated with aneurysm embolization
32. Complications associated with placement of stents
33. Other complications associated with interventional therapy and unpredictable events
34. Incompletely avoiding complications of operations

Abbreviations: SAH, subarachnoid hemorrhage; Insuff, insufficiency.

Table 2 Integrity of the communication content with severe HT patients’ families

Encounter	Undone (0–2 scores)	Insuff	Done (0–2 scores)
1. Introducing physician himself
2. Inform patients’ families of exigent communications and an upcoming emergency operation
Delivery of bad news and information of patient’s condition (3–8)
3. Diagnosis
4. Relationship between pathophysiologic procedures of trauma and symptoms and outcomes
5. Explain Glasgow coma scale and relationship with outcomes
6. Prediction of mortality and morbidity rates according to the diagnosis and patients’ situations
7. Prediction of outcome and neurofunctions according to the diagnosis and patients’ situations
8. Possible improvement or aggravation of pathogenetic condition at any time
Notify complications and risk factors (9–18)
9. Infections
10. Cerebrospinal fluid leakage
11. Cranial nerve injuries
12. Intelligence disadvantage
13. Hyponatremia or electrolyte imbalance
14. Pneumonia
15. Hydrocephalus
16. Decubital ulcer and phlebothrombosis
17. Post-traumatic epilepsy
18. Other complications associated with trauma and unpredictable events
Informed consent and treatment prescription (19–28)
19. Purpose of emergency operations
20. Outcomes associated with emergency operations
21. Define modus operandi with neurosurgeon’s help
22. Introduce main operative procedures
23. Introduce the operator
24. Express neurosurgeon’s endeavor
25. Notify the rates and complications associated with anesthesia
26. Medicine, which is science other than witchcraft, cannot cure all diseases
27. Postoperative treatment
28. Cost associated with operations
Rates and complications associated with emergency operations (29–34)
29. Intracranial hematoma
30. Neurofunctional impairment associated with operation
31. Infections associated with operation
32. Epilepsy associated with operation
33. Other complications associated with operation and unpredictable events
34. Incompletely avoiding complications of operations

Abbreviations: HT, head trauma; Insuff, insufficiency.

Table 3 Interpersonal skills inventory

	Disagree strongly	Disagree	Do not agree or disagree	Agree	Agree strongly
1. Physician introduced himself and let me know his role in therapeutic procedures.
2. The physician was warm and friendly throughout the procedure without being abrupt or impatient.
3. The physician listened carefully as I described my problem and did not interrupt me.
4. The physician encouraged me to ask questions.
5. The physician gave me adequate time to ask any questions and to express my concerns and opinions.
6. I could understand any technical or medical terms the physician explained.
7. The physician spoke clearly and precisely.
8. The physician did not lecture or talk down to me.
9. The physician showed interest, did not feel bored or ignore me when I spoke to him.
10. The physician appeared comfortable and at ease during the conversation.
11. The physician maintained appropriate eye contact with me throughout the conversation.
12. The physician ended the conversation appropriately and politely.
13. Overall, I felt comfortable with this physician.

Note: Disagree strongly to agree strongly: 1–5 scores.

Figure 1 Outline of study design.

Abbreviations: SAH, subarachnoid hemorrhage; HT, head trauma.

Table 4 Interpersonal skills and integrity of communication content comparisons

	df	MSE	F	P-value
IS aspect
SAH1
Group	1	0.028	0.008	0.929
Level	1	24.797	7.340	0.027
G × L	1	0.028	0.005	0.943
HT
Group	1	24.558	23.681	0.000
Level	1	5.558	5.359	0.049
G × L	1	0.926	0.893	0.372
SAH2
Group	1	10.704	7.593	0.025
Level	1	8.898	6.312	0.036
G × L	1	0.000	0.000	1.000
SAH2-SAH1
Group	1	9.630	7.204	0.028
Level	1	3.987	2.982	0.122
G × L	1	0.709	0.530	0.487
IC aspect
SAH1
Group	1	1.021	0.806	0.396
Level	1	311.780	246.120	0.000
G × L	1	0.083	0.066	0.804
HT
Group	1	7.787	2.202	0.176
Level	1	225.333	63.717	0.000
G × L	1	5.113	1.446	0.264
SAH2
Group	1	2.445	0.530	0.488
Level	1	178.225	38.604	0.000
G × L	1	5.672	1.228	0.300
SAH2-SAH1
Group	1	6.626	3.192	0.112
Level	1	18.542	8.933	0.017
G × L	1	4.380	2.110	0.184

Abbreviations: df, degrees of freedom; MSE, mean square error; IS, interpersonal skills; SAH1, first subarachnoid hemorrhage scenario; G × L, group times level; HT, head trauma; SAH2, second subarachnoid hemorrhage scenario; IC, integrity of communication content.

Table 5 Paired Student’s t-test between SAH1 and SAH2

	SAH1		SAH2		P-value
	Mean	Std	Mean	Std
IS
Feedback	57.10	2.72	60.00	1.73	0.031
No feedback	57.00	1.76	58.11	1.06	0.020
IC
Feedback	57.85	2.26	60.86	1.71	0.041
No feedback	58.43	2.37	59.96	2.11	0.005

Abbreviations: SAH1, first subarachnoid hemorrhage scenario; SAH2, second subarachnoid hemorrhage scenario; Std, standard; IS, interpersonal skills; IC, integrity of communication content.

Figure 2 IC scores in three scenarios.

Notes: Columns represent the mean IC scores of group consisting of residents’ and attending doctors’ scores. *Significant difference between levels in a scenario (P<0.05). No statistical difference was found between groups only levels in all the scenarios.
Abbreviations: IC, integrity of communication content; SAH1, First subarachnoid hemorrhages scenario; SAH2, Second subarachnoid hemorrhage scenario; HT, head trauma.

Figure 3 IS scores in three scenarios.

Notes: Columns represent the mean IS scores of group consisting of residents’ and attending doctors’ scores. *Significant difference between levels in a scenario (P<0.05). Significant statistical differences were found between groups in HT and second SAH scenarios. The performances of residents and attending doctors did not differ significantly in all scenarios.
Abbreviations: IS, interpersonal skills; HT, head trauma; SAH1, First subarachnoid hemorrhages scenario; SAH2, Second subarachnoid hemorrhage scenario.