Medical Student Johns Hopkins University School of Medicine Baltimore, Maryland, United States
Background: Many parents have concern and anxiety about their children undergoing anesthesia. Communication about anesthesia between clinicians and families during surgical consultations may vary. Objective: We aim to characterize dialogue that clinicians use to discuss anesthesia with patients and families. Design/Methods: Outpatient clinical consultations between families and surgical clinicians for tonsillectomy, hernia repair, or circumcisions were audio-recorded and transcribed. Transcripts were reviewed to identify all clinical discussion related to anesthesia. Thematic content analysis was performed by manually coding dialogue according to themes based on their content and depth of discussion. Initially, 80% of the transcripts were double-coded and evaluated to establish high interrater agreement. Differences were reviewed and discussed by both coders. Descriptive statistics were obtained to enumerate the different themes. Results: Of the 149 transcripts analyzed, 89 (59.7%) contained discussions of anesthesia. An agreement percentage of 93% was found to confirm interrater reliability. Transcripts that mentioned anesthesia were first categorized by depth: brief or implied discussion (n=44, 49.4%) and contextualized discussion (n=37, 50.6%). Themes of brief/implied discussion included questions of anesthesia history (n=31, 34.8%; eg “No anesthesia problems?”) and matter-of-fact statements (n=18, 20.2%; eg “he’d be under general anesthesia, be totally asleep”). Contextualized discussions of anesthesia included consoling/qualifying statements (n=21, 23.6%; eg “You won’t feel a single thing…”), information about risks (n=26, 29.2%; eg “risk of anesthesia goes down to what it is for us around 3 to 6 months of age…” ), process description (n=20, 22.5%; eg “You get to choose, like, a little flavor, and then they put the mask on”), and acknowledgement of the stressful nature of the topic (n=3, 3.4%; eg “anesthesia in general is just stressful”). In 19 transcripts (12.8%), the parents directly asked or expressed concern about anesthesia. All 19 encounters contained clinical discussion of anesthesia with 2 (10.5%) classified as brief/implied and 17 (89.5%) classified as contextualized.
Conclusion(s): Pediatric surgeons discuss anesthesia with parents in various ways. These results may be used to consider verbiage to allay parental concerns regarding anesthesia. Future research may evaluate how communication about anesthesia during consultation influences parental anxiety and decision conflict.
