Exploration of doctor-patient communication characteristics and optimization path for gastrointestinal surgery of acute abdomen

Abstract

BACKGROUND

Gastrointestinal surgical acute abdomen conditions. These conditions not only cause significant suffering to patients but also increase psychological stress for both patients and their families.

AIM

To investigate communication characteristics in gastrointestinal surgical acute abdomen cases (such as appendicitis and pancreatitis) and explore optimization pathways.

METHODS

Eighty-two patients with gastrointestinal surgical acute abdomen (including appendicitis and pancreatitis) admitted to the hospital between November 2022 and June 2024 were selected. Physician-patient communication characteristics were analyzed. Patients were randomly divided into two groups (41 each) using a random draw method. The control group received conventional physician-patient communication. The observation group received an optimized communication model based on the conventional method. The two groups were compared for treatment efficacy and outcomes, psychological status, coping strategies, sleep quality, and compliance.

RESULTS

Significant differences were observed between the two groups in terms of time to ambulation and duration of hospital stay (P < 0.05), whereas hospitalization costs were not significantly different (P > 0.05). After the intervention, the psychological status scale scores in both groups decreased significantly (P < 0.05), with significant differences between the groups (P < 0.05). Following the intervention, the facing subscale scores of the medical coping questionnaire increased, while the avoidance and submission subscale scores decreased (P < 0.05), with significant differences between the groups (P < 0.05). The observation group had lower scores on the sleep quality scale (P < 0.05). The compliance rate was higher in the observation group (97.56% vs 80.49%, P < 0.05).

CONCLUSION

Physician-patient communication presented contradictions between professionalism and laymen’s expression and rigid communication methods. Optimizing communication models can improve sleep quality, coping strategies, patient compliance, and treatment outcomes and reduce negative emotions.

Key Words: Gastrointestinal surgical acute abdomen; Appendicitis; Pancreatitis; Physician-patient communication; Optimization pathway

Core Tip: Effective physician-patient communication is crucial for patients with a gastrointestinal surgical acute abdomen. Treatment efficiency and outcomes can be improved by analyzing communication characteristics and optimizing the existing model.

INTRODUCTION

In recent years, with the continuous development of medical service concepts, a patient-centered service philosophy has been increasingly emphasized. Along with the advancement of new medical policies, the physician-patient relationship has garnered widespread attention[1]. Physician-patient communication primarily involves the exchange of disease-related knowledge between physicians and patients, encompassing verbal and emotional support. This process plays a significant role in establishing a positive physician-patient relationship and reducing conflicts[2].

Gastrointestinal surgical acute abdomen conditions, including appendicitis and pancreatitis, are characterized by acute abdominal emergencies with sudden onset and severe abdominal pain. These conditions not only cause significant suffering to patients but also increase psychological stress for both patients and their families[3,4]. Therefore, effective physician-patient communication is particularly important for patients with gastrointestinal surgical acute abdomen. However, at present, factors such as treatment costs and therapeutic outcomes pose certain challenges to physician-patient communication. Additionally, the pursuit of professionalism and rigor in medical knowledge requires physicians to consider the patients' individual circumstances, such as comprehension abilities and disease severity, during communication. Variations in language and tone among physicians may lead to misunderstandings or unclear expressions. Meanwhile, patients’ cultural backgrounds and comprehension abilities also affect communication outcomes, resulting in contradictions between professionalism and layman’s expressions, as well as a lack of flexibility in communication methods[5]. These issues impact the effectiveness of physician-patient communication. To enhance physician-patient communication outcomes for patients with gastrointestinal surgical acute abdomen, it is necessary to explore optimization pathways to improve patient prognosis.

To analyze the characteristics of physician-patient communication and explore optimization pathways in patients with gastrointestinal surgical acute abdomen, 82 patients with gastrointestinal surgical acute abdomen were selected for analysis. The details are presented in the following sections.

MATERIALS AND METHODS

Clinical data

A total of 82 patients with gastrointestinal surgical acute abdomen admitted to our hospital between November 2022 and June 2024 were selected and randomly divided into two groups (41 patients each) using a random draw method. The inclusion criteria were as follows: (1) Patients diagnosed with gastrointestinal surgical acute abdomen by ultrasound, laparoscopy, or other diagnostic methods; (2) Patients with normal cognitive function; (3) Patients with normal language and auditory functions and capable of normal communication with others; and (4) Patients who underwent surgical treatment. The exclusion criteria were as follows: (1) Systemic inflammatory response; (2) Abnormal cardiopulmonary function; and (3) Psychiatric disorders such as depression.

In the data collection section, snowball sampling was utilized to distribute electronic questionnaires. Initially, a small number of eligible patients were identified and invited to participate. The patients were provided with a quick response code to complete the survey. Subsequently, participants were asked to recommend other potential participants who met the study criteria. Each participant was provided a quick response code to complete the survey. This process was continued until the desired sample size of 400 questionnaires was reached, with 384 valid responses collected, resulting in an effective recovery rate of 96.0%. This method allowed for gradual expansion of the sample, enabling the collection of a sufficient number of participants for the study.

To ensure the rigor of the study design, a random draw method was employed to allocate patients to the control and observation groups. Specifically, a list of all eligible patients was compiled, and a random number table was used to generate a sequence of random numbers. The patients were then assigned to either the control or observation group based on these random numbers to ensure an equal distribution of 41 patients in each group. To maintain allocation concealment and minimize selection bias, the randomization process was conducted by an independent researcher who was not involved in subsequent data collection or analysis. The group assignments were sealed in opaque envelopes and only disclosed after the patients consented to participate and completed the baseline assessments. This approach ensured that both researchers and patients were unaware of the group assignments until the finalization of the baseline data, thereby preserving the integrity of the randomization process and enhancing the validity of the study findings.

Methods

The control group implemented routine doctor-patient communication. After the patients were admitted to the hospital, information regarding acute abdomen in gastrointestinal surgery, such as disease type, harm, treatment methods, etc., was orally communicated to them. They were further informed about matters requiring attention during the treatment process and possible complications. Any questions raised by the patients were answered in detail.

The observation group optimized the physician-patient communication model based on conventional communication methods, with the following specific measures.

Communication team: An optimization team for physician-patient communication was established, with the head of the gastrointestinal surgery department serving as the team leader and the attending physicians as team members. The team leader was responsible for departmental research, formulating specific communication measures, developing training plans for team members, and evaluating communication effectiveness. Team members were responsible for implementing specific communication measures.

Standardizing the communication process: Team members communicated with patients following assessment, planning, implementation, and evaluation. After the patient was admitted, a comprehensive assessment of each patient’s actual situation, including personality traits, disease severity, and personal customs, was conducted. Based on the assessment results, a targeted communication plan was developed that specified the timing, content focus, and expected outcomes of the communication. The communication plan was implemented with an ongoing evaluation of its effectiveness and timely adjustments to communication strategies, as needed.

Optimizing specific communication measures: Physicians were expected to maintain a professional appearance to make a good impression on patients. They used comforting, explanatory, and encouraging language when communicating with patients. For example, they might say: “Hello, I am your attending physician. I will do my best to understand your condition and develop the most suitable treatment plan for you”; or “Don’t look so worried. I have seen patients with conditions much worse than yours who have already recovered”; or “Don’t worry, everything will be fine”. Physicians also used plain language to explain information related to gastrointestinal surgical acute abdomen.

Different communication skills were used based on the personality of the patient. For example, for irritable patients, listening skills were used to understand their feelings and reasons for anger, and comfort was provided based on the patient’s perspective.

For patients with depressive tendencies, communication techniques such as venting, listening, silence, and touch were used with a warm and amiable attitude. For patients with critical conditions, the communication content was simplified, and the interaction time was shortened while observing the patient’s reactions. Repeated communication and patience were required in patients with poor comprehension.

Observational indicators

Treatment efficiency and effect: The activity time, hospitalization time, and hospitalization costs of the two groups were recorded.

Psychological state: The anxiety self-assessment scale (SAS) and depression self-assessment scale (SDS) evaluated the psychological state of patients before the intervention. SAS, SDS score are 0-100, 50 is divided into anxiety, depression, > 50, 53, patients with anxiety, depression. The higher the score, the more serious the anxiety and depression.

Response: Response was checked before the intervention using the medical response questionnaire (MCMQ). The scale included 20 items for the three dimensions of face, avoidance, and yield, including 8, 7, and 5 items, respectively. Each item was scored on a scale of 1-4, with higher scores indicating a higher frequency of response.

Sleep quality: Sleep quality was measured before and after the intervention using the Pittsburgh sleep quality index table (PSQI). The scale has seven dimensions, including sleep quality and sleep time, both rated on a scale of 0-3. The higher the patient score, the worse the sleep quality.

Compliance: Compliance was measured after the intervention. Complete compliance meant patients were fully voluntarily compliant and highly cooperative with medical staff; Partial compliance meant that though mostly compliant, patients were occasionally disobedient, it did not affect clinical work; Complete noncompliance meant patients did not comply with medical staff, affecting clinical work. Adherence = (complete compliance + partial compliance)/100% of total cases.

Statistical analysis

Data processing SPSS22.0 software was used for data processing. Count data n (%), measurement data (mean ± SD), independent sample t-test, and paired t-test were used for data comparison. Statistical significance was noted at P < 0.05.

RESULTS

Basic information

The control group comprised 22 males and 19 females, with an age range of 27-58 years (mean ± SD: 42.63 ± 5.66 years). The time from onset to hospital admission was 2-18 hours (mean ± SD: 10.46 ± 2.77 hours). The disease types included 16 cases of appendicitis, 18 cases of pancreatitis, and seven other types. In the observation group, the male-to-female ratio was 21:20, with an age range of 26-59 years (mean ± SD: 42.57 ± 5.40 years). The time from onset to hospital admission was 2-19 hours (mean ± SD: 10.70 ± 2.42 hours). The disease types included 17 cases of appendicitis, 19 cases of pancreatitis, and five other types. There were no significant differences in the clinical data between the two groups (P > 0.05) (Table 1).

Table 1 Comparison of clinical data between the control and observation group characteristics, mean ± SD.

	Control (n = 41)	Observation (n = 41)	P value
Gender
Male	22	21	> 0.05
Female	19	20
Age (years)	42.63 ± 5.66	42.57 ± 5.40	> 0.05
Time from onset to admission (hours)	10.46 ± 2.77	10.70 ± 2.42	> 0.05
Disease type
Appendicitis	16	17	> 0.05
Pancreatitis	18	19
Other	7	5

No significant differences were observed between the two groups in terms of sex, age, time from onset to admission, or disease type (P > 0.05).

Comparison of treatment efficiency and effect between the two groups

The ambulation and hospitalization durations were shorter in the observation group than in the control group (P < 0.05). There was no significant difference between the two groups (P > 0.05), as shown in Table 2.

Table 2 Comparison of treatment efficiency and effect between the two groups, mean ± SD.

Group	Number of cases	Time to ambulation (hour)	Hospital stay duration (day)	Hospitalization costs (Chinese yuan)
Observation	41	13.25 ± 1.05	4.13 ± 0.56	2658.14 ± 49.88
Control	41	16.55 ± 1.40	5.78 ± 0.40	2677.46 ± 49.35
t value		12.074	15.352	1.763
P value		< 0.001	< 0.001	0.082

Comparison of the psychological status of the two groups

Before the intervention, the psychological status scores of the different groups were not significantly different (P > 0.05). After the intervention, the SAS and SDS scores of both groups decreased significantly (P < 0.05), and the observation group varied significantly (P < 0.05), as shown in Table 3.

Table 3 Comparison of psychological status between the two groups, mean ± SD.

Group	Cases	SAS		SDS
		Before	After	Before	After
Observation	41	54.05 ± 4.55	40.22 ± 3.77a	56.78 ± 4.03	41.35 ± 4.06a
Control	41	54.12 ± 4.43	42.63 ± 3.59a	56.29 ± 4.29	44.29 ± 4.57a
t value		0.071	2.964	0.533	3.080
P value		0.944	0.004	0.595	0.003

^aP < 0.05.

P compared with the pre-intervention session. SAS: Anxiety self-assessment scale; SDS: Depression self-assessment scale.

Comparison of response between the two groups

Before the intervention, there was no significant difference in the response scale scores (P > 0.05). After the intervention, the MCMQ scores increased, avoidance and yield scores decreased (P < 0.05), and the difference between groups was significant (P < 0.05), as shown in Table 4.

Table 4 Comparison of coping methods between the two groups, mean ± SD.

Group	Cases	Face		Avoid		Surrender
		Before	After	Before	After	Before	After
Observation	41	15.78 ± 1.40	23.06 ± 1.73a	14.51 ± 1.24	10.77 ± 0.98a	13.06 ± 1.26	8.43 ± 0.77a
Control	41	15.46 ± 1.33	19.77 ± 1.44a	14.46 ± 1.30	12.14 ± 1.03a	13.17 ± 1.40	9.46 ± 0.84a
t value		1.061	9.359	0.178	6.170	0.374	5.788
P value		0.292	< 0.001	0.859	< 0.001	0.709	< 0.001

^aP < 0.05.

P compared with the pre-intervention session.

Comparison of sleep quality between the two groups

Before the intervention, the sleep quality scale scores of the two groups were not significantly different (P > 0.05). After the intervention, the PSQI score of the observation group was relatively low (P < 0.05), and the two groups were significantly different (P < 0.05), as shown in Table 5.

Table 5 Comparison of sleep quality between the two study groups, mean ± SD.

Items	Times	Case	Observation	Control	t value	P value
Sleep time	Before	41	2.37 ± 0.45	2.44 ± 0.41	0.736	0.464
	After	41	1.36 ± 0.29a	1.77 ± 0.33a	5.976	< 0.001
Sleep quality	Before	41	2.40 ± 0.37	2.38 ± 0.32	0.262	0.794
	After	41	1.47 ± 0.29a	1.66 ± 0.38a	2.545	0.013
Hour of sleep	Before	41	1.89 ± 0.16	1.91 ± 0.18	0.532	0.596
	After	41	1.27 ± 0.22a	1.40 ± 0.27a	2.390	0.019
Sleep efficiency	Before	41	1.44 ± 0.20	1.46 ± 0.26	0.390	0.697
	After	41	0.81 ± 0.10a	0.98 ± 0.14a	6.327	< 0.001
Ambulatory medicine	Before	41	1.39 ± 0.22	1.40 ± 0.27	0.184	0.855
	After	41	0.74 ± 0.09a	0.88 ± 0.10a	6.663	< 0.001
Dyssomnia	Before	41	1.50 ± 0.20	1.51 ± 0.23	0.210	0.834
	After	41	1.03 ± 0.14a	1.19 ± 0.18a	4.493	< 0.001
Daytime function	Before	41	1.88 ± 0.26	1.90 ± 0.27	0.342	0.734
	After	41	1.13 ± 0.30a	1.29 ± 0.24a	2.667	0.009

^aP < 0.05.

P compared with the pre-intervention session.

Comparison of compliance between the two groups

The adherence rate in the observation group was 97.56%, which was higher than the 80.49% in the control group (P < 0.05), as shown in Table 6.

Table 6 Comparison of compliance between the two groups, n (%).

Group	Case	Full compliance	Part of the compliance	No compliance at all	Compliance rate
Observation	41	22 (53.66)	18 (43.90)	1 (2.44)	40 (97.56)
Control	41	19 (46.34)	14 (34.15)	8 (19.51)	33 (80.49)
χ2 value					4.493
P value					0.034

DISCUSSION

Analysis of communication characteristics in gastrointestinal surgical acute abdomen cases

Physician-patient communication is a crucial component of medical practice and the primary condition for harmonious physician-patient relationships. The quality of physician-patient relationships directly affects medical quality, with good relationships ensuring smooth medical activities[6]. In recent years, physician-patient relationships in China have become increasingly tense, and conflicts have become more pronounced. Effective communication can enhance patients’ trust in medical staff, reduce conflict, and improve the quality of medical care[6]. Gastrointestinal surgical acute abdomen conditions such as appendicitis and pancreatitis are common clinical diseases characterized by rapid onset and severe abdominal pain. If not promptly managed, conditions such as acute pancreatitis can lead to shock and life-threatening complications[7]. These disease characteristics pose significant challenges for physician-patient communication. Currently, communication in gastrointestinal surgical acute abdomen cases primarily relies on verbal exchanges, with limited attention paid to patients’ comprehension levels and individual characteristics. This approach often results in suboptimal communication outcomes, hindering the establishment of good physician-patient relationships. Therefore, exploring optimization pathways for physician-patient communication is essential for improving medical outcomes.

Exploration of optimization pathways for physician-patient communication

In this study, the observation group exhibited significantly shorter durations of ambulation and hospital stays (P < 0.05), indicating that optimizing physician-patient communication based on conventional methods can enhance the efficiency and outcomes of treatment for gastrointestinal surgical acute abdomen cases. The optimization process began with establishing a communication team led by the department head, who was responsible for developing training programs for team members and supervising the implementation of the optimized communication model to ensure its scientific and rational application[8]. The communication process was standardized to follow an assessment, planning, implementation, and evaluation protocol[9-11]. Initial patient assessments guided the selection of tailored communication strategies, enhancing the specificity of the communication model[12,13]. Additionally, specific measures were optimized, such as using encouraging language to alleviate patients’ anxiety and build trust, thereby improving cooperation and treatment outcomes[14].

Patients with gastrointestinal surgical acute abdomen often experience severe pain and rapid disease progression, which can induce worry and anxiety, affecting their trust in medical staff and the overall prognosis[15,16]. The SAS and SDS are commonly used to assess patients’ psychological states[17]. In this study, SAS and SDS scores were used to evaluate the improvement in negative emotions in patients[18]. Post-intervention data showed significant reductions in SAS and SDS scores in both groups (P < 0.05), with lower scores in the observation group (P < 0.05). This indicates that optimized communication is more effective than conventional methods in alleviating negative emotions[19-22]. The optimization process involved assessing the patients’ personality traits, disease severity, and cultural backgrounds to tailor communication strategies. For example, patients prone to anger were approached empathetically, whereas those with depressive tendencies were approached with a warm and amiable demeanor[23-25]. These strategies helped mitigate negative emotions, reduce resistance from medical staff, and improve SAS and SDS scores[26].

Gastrointestinal surgical acute abdomen conditions require timely and effective treatment; however, the associated discomfort can lead to negative coping behaviors, affecting patient outcomes[27]. Data from Table 3 show significant differences in MCMQ scores between the two groups post-intervention (P < 0.05), indicating that optimized communication improves coping strategies. By understanding patients’ individual circumstances and building trust through effective communication, medical staff can facilitate cooperation, accelerate disease recovery, and improve sleep quality and coping behaviors[28,29]. Table 5 demonstrates a higher compliance rate in the observation group (97.56%) than in the control group (80.49%; P < 0.05). Additionally, lower scores on the PSQI in the observation group post-intervention (P < 0.05) further support the notion that optimized communication improves sleep quality and compliance. However, no significant differences were observed in hospitalization costs between the groups (P > 0.05), suggesting that optimizing communication had a minimal impact on medical expenses.

Efficiency of message delivery

Effective communication ensures that patients quickly understand medical information, reduces misunderstandings, and reduces unnecessary time costs. Traditional doctor-patient communication often uses complex medical terminology, which patients may find difficult to understand. In the optimized communication model, doctors are trained to use simple and understandable language to convey information, avoiding the use of obscure terms. When explaining treatment plans, doctors use visual aids such as diagrams and models to help patients better comprehend their condition and the treatment process. This improves the efficiency of message delivery, enabling patients to quickly understand the key points of a treatment plan and make informed decisions, thereby enhancing treatment efficiency.

Limitations

In summary, optimizing doctor-patient communication can improve treatment efficiency and patient compliance. However, this study has some limitations. For instance, the sample size was relatively small. Furthermore, the study was conducted at a single medical institution, possibly limiting the generalizability of the findings. In addition, the long-term effects of the communication optimization model were not assessed. Future research should address these limitations to further enhance the scientific validity and practical applicability of our findings.

CONCLUSION

This study analyzed 82 cases of gastrointestinal surgical acute abdomen and identified issues, such as the contradiction between professional and layman expressions and a lack of flexibility in communication methods. These issues contributed to suboptimal communication outcomes. By optimizing conventional communication methods, such as establishing a communication team and standardizing communication processes, significant improvements were observed in treatment efficiency, psychological state, coping strategies, sleep quality, and compliance. However, this study’s limitations, including its relatively small sample size, may have affected its scientific validity. Future studies should involve larger cohorts to further validate the findings.