Communications skills keep surgical patients engaged, informed

Editor's Note

An April 16 article in JAMA Network outlines a three-part communications framework for improving the quality and clarity of perioperative conversations with patients, particularly when time is limited and stakes are high.

The article focuses particularly on three core communications skills: attending to emotion, managing uncertainty, and supporting deliberation. Emotion, authors explain, is often neglected amid the focus on procedural details of standard informed consent practices. The case is the same for the practical aspects patients and families must consider to navigate complex choices. Skillful communication can help patients feel seen, respected, and engaged in their own care.

According to the article, difficult conversations should begin with a “heads-up” (such as “I have serious news”) followed by a clear and concise summary of the situation. This approach helps patients absorb information without getting overwhelmed by technical language. Using strategies such as the NURSE mnemonic and “I wish” statements can convey compassion and ensure empathetic communication, particularly when surgery is unlikely to meet patient goals.

To manage uncertainty, the article advocates for using scenario planning rather than predicting a single outcome. Offering narratives for best- and worst-case scenarios can help patients visualize future possibilities and supports shared decision-making, even amid acute illness or life-limiting conditions.  

Finally, the article advises clearly defining the goals of surgery, as opposed to describing how procedures are performed. Relying on a “fix-it” model focused on anatomical repair may leave patients with an oversimplified view of what surgery can accomplish. Also describing potential downsides such as pain, prolonged recovery, or loss of function—even in the absence of complications—can help patients weigh trade-offs.