A Surgeon’s Review for Difficult Conversations

Abstract

The goal of this review is to synthesize a strategy for difficult conversations using evidence from the literature and our experience in surgical and palliative care practice. Several published and established resources can inform surgeons’ communication skills. Vital Talk and the Serious Illness Care Program are formal training programs of four days and a half-day in length, respectively, for improving providers’ communication skills. The Best Case/Worst Case tool is a decision aid developed by surgeons for surgeons guiding patients through difficult choices. Published frameworks such as SPIKES and ABCDE outline key steps to navigate challenging conversations and break bad news. Numerous factors contribute to quality of communication, including setting, positioning of participants, open-ended questions, clear and concise language, responding to emotion, and engaging in shared decision-making. We describe a strategy for difficult conversations that is tailored for use by surgeons and modeled on surgical principles.