Communication in Anaesthesia: A Systematic Review of the Literature
CCCF ePoster library. Tylee M. Nov 1, 2016; 150928; 49 Disclosure(s): None to declare
Mike Tylee
Mike Tylee
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Topic: Systematic Review, Meta-analysis, or Meta-synthesis

Communication in Anaesthesia: A Systematic Review of the Literature

Tylee, Michael1; Rubenfeld, Gordon2; Hussein, Sajid3; Sklar, Michael4; Adhikari, Neill2

1Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario; 2Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program, Sunnybrook Research Institute, Toronto, Ontario; 3Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario; 4Department of Anaesthesia, University of Toronto, Toronto, Ontario


Introduction: Anaesthesiologists see patients prior to surgery, and during these clinical encounters they frequently discuss the options for perioperative care with patients. Despite the importance of communication in medicine, there are little data on the content and patterns of communication between patients and anaesthesia providers.

Objectives: To systematically review the existing literature on anaesthesia-patient communication, including assessment of the quality of existing studies and a qualitative collation of data.

Methods: We searched MEDLINE (1980 to February 2016) and studies citing and cited by included studies in Web of Science, and selected studies describing specific encounters between adult patients and anaesthesia providers.  We excluded studies that were not primarily about communication, that only included pediatric patients, or that examined adjuncts to communication.  We extracted and collated data regarding study objectives, study design, methodology, measures, outcomes, patient characteristics, and clinical setting.  Methodological quality was assessed using the Critical Appraisal Skills Program tools1.

Results: 3021 citations resulted from on the MEDLINE search, 11 of which were eligible for inclusion in the review2-12.  Two additional studies were found in the Web of Science search13,14.  The collated data demonstrate that communication between patients and anaesthesia providers is dominated by the exchange of simple clinical information with relatively little discussion of risks and benefits or patient counseling.  Additional findings regarding perioperative communication were that patients frequently wish to be involved in perioperative decision making, but are often limited by an incomplete understanding of risks and benefits, and that anaesthesia providers adjust the amount of information disclosed based on perceived patient desires, but often give patients unmanageable amounts of information during consultation.  Regarding communication in the operating room, we found data demonstrating that anesthesia providers are focused on patient reassurance.  We found no data demonstrating communication between anaesthesia providers and patients focused on decisions that have implications beyond the operating room or focused on overall goals of care.

Conclusions: Communication in anaesthesia is dominated by exchange of simple clinical information with relatively little discussion of risks and benefits or patient counseling.  Although patients may often desire to be involved in perioperative decision making, they are frequently overwhelmed with the amount of information provided, and may not be adequately counseled on risks and benefits when making perioperative decisions.  It is not clear if or how anaesthesiologists help patients make decisions that extend beyond the operating room, including decisions around post-operative management and overall goals of care.  Many questions remain about optimal communication involving anaesthesia providers.

  1. Critical Appraisal Skills Programme (CASP); 2013.!checklists/cb36 [accessed March 15, 2015].
  2. Babitu UQ, Cyna AM: Patients’ understanding of technical terms used during the pre-anaesthetic consultation. Anaesthesia & Intensive Care 2010; 38:349–53
  3. Barneschi MG, Miccinesi G, Marini F, Bressan F, Paci E: Informing patients about risks and complications of anaesthesia. Minerva Anestesiologica 2002; 68:811–8
  4. Flierler WJ, Nubling M, Kasper J, Heidegger T: Implementation of shared decision making in anaesthesia and its influence on patient satisfaction. Anaesthesia 2013; 68:713–22
  5. Kindler CH, Szirt L, Sommer D, Hausler R, Langewitz W: A quantitative analysis of anaesthetist-patient communication during the pre-operative visit. Anaesthesia 2005; 60:53–9
  6. Lagana Z, Foster A, Bibbo A, Dowling K, Cyna AM: Consent for pediatric anesthesia: an observational study. Paediatric Anaesthesia 2012; 22:787–92
  7. Nuebling M, Kindler CH, Langewitz W: Preoperative visits in anesthesia: communication patterns and sequences: application of an explorative analysis. Patient Education & Counseling 2004; 54:379–81
  8. Sandberg EH, Sharma R, Wiklund R, Sandberg WS: Clinicians consistently exceed a typical person’s short-term memory during preoperative teaching. Anesthesia & Analgesia 2008; 107:972–8
  9. Tait AR, Voepel-Lewis T, Gauger V: Parental recall of anesthesia information: informing the practice of informed consent. Anesthesia & Analgesia 2011; 112:918–23
  10. Zollo RA, Lurie SJ, Epstein R, Ward DS: Patterns of communication during the preanesthesia visit. Anesthesiology 2009; 111:971–8
  11. Slater P, Sellors J, Cyna AM: Communications during epidural catheter placement for labour analgesia. Anaesthesia 2011; 66:1006–11
  12. Smith AF, Pope C, Goodwin D, Mort M: Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence. Journal of Anaesthesia 2005; 52:915–20
  13. Berg K, Kaspersen R, Unby C, Hollman Frisman G: The interaction between the patient and nurse anesthetist immediately before elective coronary artery bypass surgery. J Perianesth Nurs 2013; 28:283–90
  14. Trumble J, Lee PM, Sellors J, Cyna AM: Consent for labour epidural analgesia: an observational study in a single institution.  Anaesthesia and Intensive Care 2015; 43:323-27

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