Transforming Surgical and Interventional Care: Insights from the Robert Wood Johnson Foundation Clinical Scholars Program| Volume 155, ISSUE 5, P841-850, May 2014

Download started.


The effect of complications on the patient-surgeon relationship after colorectal cancer surgery

Published:December 16, 2013DOI:


      Trust in physicians is an essential part of therapeutic relationships. Complications are common after colorectal cancer procedures, but little is known of their effect on patient-surgeon relationships. We hypothesized that unexpected complications impair trust and communication between patients and surgeons.


      We performed a population-based survey of surgically diagnosed stage III colorectal cancer patients in the Surveillance Epidemiology and End Results registries for Georgia and Metropolitan Detroit between August 2011 and October 2012. Using published survey instruments, we queried subjects about trust in and communication with their surgeon. The primary predictor was the occurrence of an operative complication. We examined patient factors associated with trust and communication then compared the relationship between operative complications and patient-reported trust and communication with their surgeons.


      Among 622 preliminary respondents (54% response rate), 25% experienced postoperative complications. Those with complications were less likely to report high trust (73% vs 81%, P = .04) and high-quality communication (80% vs 95%, P < .001). Complications reduced trust among only 4% of patient-surgeon dyads with high-quality communication, whereas complications diminished patients' trust in 50% with poorer communication (P < .001). After controlling for communication ratings, we found there was no residual effect of complications on trust (P = .96).


      Most respondents described trust in and communication with their surgeons as high. Complications were common and were associated with lower trust and poorer communication. However, the relationship between complications and trust was modified by communication. Trust remained high, even in the presence of complications, among respondents who reported high levels of patient-centered communication with their surgeons.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Morris A, Alexander G, Murphy M, Thompson P, Elston-Lafata J, Birkmeyer J. Race & Patient Perspectives on Chemotherapy for Colorectal Cancer. In: Academy Health 26th Annual Research Meeting. Chicago, IL; 2009.

        • Kahn K.L.
        • Schneider E.C.
        • Malin J.L.
        • Adams J.L.
        • Epstein A.M.
        Patient centered experiences in breast cancer: predicting long-term adherence to tamoxifen use.
        Med Care. 2007; 45: 431-439
        • Hall M.A.
        • Dugan E.
        • Zheng B.
        • Mishra A.K.
        Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?.
        Milbank Q. 2001; 79 (v): 613-639
        • Caterinicchio R.P.
        Testing plausible path models of interpersonal trust in patient-physician treatment relationships.
        Soc Sci Med Part A. 1979; 13: 81-99
        • Hall M.A.
        • Zheng B.
        • Dugan E.
        • et al.
        Measuring patients' trust in their primary care providers.
        Med Care Res Rev. 2002; 59: 293-318
        • Trachtenberg F.
        • Dugan E.
        • Hall M.A.
        How patients' trust relates to their involvement in medical care.
        J Family Practice. 2005; 54: 344-352
        • Inui T.S.
        • Carter W.B.
        • Kukull W.A.
        • Haigh V.H.
        Outcome-based doctor-patient interaction anaylsis: I. Comparison of techniques.
        Med Care. 1982; 20: 535-549
        • Galassi J.P.
        • Schanberg R.
        • Ware W.B.
        The Patient Reactions Assessment: a brief measure of the quality of the patient-provider medical relationship.
        Psychol Assess. 1992; 4: 346-351
        • Axelrod Da G.S.
        Maintaining trust in the surgeon-patient relationship: challenges for the new millennium.
        Arch Surg. 2000; 135: 55-61
        • Heer F.
        The place of trust in our changing surgical environment.
        Arch Surg. 1997; 132: 809-814
        • Cohen M.E.
        • Bilimoria K.Y.
        • Ko C.Y.
        • Hall B.L.
        Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery.
        J Am Coll Surg. 2009; 208: 1009-1016
        • Schilling P.L.
        • Dimick J.B.
        • Birkmeyer J.D.
        Prioritizing quality improvement in general surgery.
        J Am Coll Surg. 2008; 207: 698-704
        • Gawande A.A.
        • Thomas E.J.
        • Zinner M.J.
        • Brennan T.A.
        The incidence and nature of surgical adverse events in Colorado and Utah in 1992.
        Surgery. 1999; 126: 66-75
      2. Cancer Facts & Figures 2012. American Cancer Society, Atlanta (GA)2012
      3. National Center for Health Statistics. NCHS FASTATS—Inpatient surgery, 2009. Available from

        • Dillman D.A.
        Mail and telephone surveys: the total design method.
        Wiley, New York1978
        • Kaiser K.
        • Rauscher G.H.
        • Jacobs E.A.
        • Strenski T.A.
        • Ferrans C.E.
        • Warnecke R.B.
        The import of trust in regular providers to trust in cancer physicians among White, African American, and Hispanic Breast Cancer Patients.
        J Gen Intern Med. 2011; 26: 51-57
        • D'Angelica M.
        • Hirsch K.
        • Ross H.
        • Passik S.
        • Brennan M.F.
        Surgeon-patient communication in the treatment of pancreatic cancer.
        Arch Surg. 1998; 133: 962-966
        • Roberts C.A.
        • Aruguete M.S.
        Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician–patient encounters.
        Soc Sci Med. 2000; 50: 309-315
        • Ben-Sira Z.
        Affective and instrumental components in the physician-patient relationship: an additional dimension of interaction theory.
        J Health Social Behav. 1980; 21: 170-180
        • Thom D.H.
        • Hall M.A.
        • Pawlson L.G.
        Measuring patients' trust in physicians when assessing quality of care.
        Health Aff (Millwood). 2004; 23: 124-132
        • Thom D.H.
        • Campbell B.
        Patient-physician trust: an exploratory study.
        J Family Pract. 1997; 44: 169-176
        • Keating N.L.
        • Gandhi T.K.
        • Orav E.J.
        • Bates D.W.
        • Ayanian J.Z.
        Patient characteristics and experiences associated with trust in specialist physicians.
        Arch Intern Med. 2004; 164: 1015-1020
        • Rosoff S.M.
        • Leone M.C.
        The public prestige of medical specialties:overviews and undercurrents.
        Soc Sci Med. 1991; 32: 321-326
        • Bosk C.
        Forgive and remember: managing medical failure.
        University of Chicago, Chicago1979: 112-146
        • Chandawarkar R.Y.
        • Ruscher K.A.
        • Krajewski A.
        • et al.
        Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.
        Arch Surg. 2011; 146: 916-921
        • Hutul O.A.
        • Carpenter R.O.
        • Tarpley J.L.
        • Lomis K.D.
        Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency.
        Curr Surg. 2006; 63: 401-409
        • Lee Y.Y.
        • Lin J.L.
        How much does trust really matter? A study of the longitudinal effects of trust and decision-making preferences on diabetic patient outcomes.
        Patient Educ Couns. 2011; 85: 406-412
        • Jacobs E.A.
        • Rolle I.
        • Ferrans C.E.
        • Whitaker E.E.
        • Warnecke R.B.
        Understanding African Americans' views of the trustworthiness of physicians.
        J Gen Intern Med. 2006; 21: 642-647
        • Piette J.D.
        • Heisler M.
        • Krein S.
        • Kerr E.A.
        The role of patient-physician trust in moderating medication nonadherence due to cost pressures.
        Arch Intern Med. 2005; 165: 1749-1755
        • Safran D.G.
        • Taira D.A.
        • Rogers W.H.
        • Kosinski M.
        • Ware J.E.
        • Tarlov A.R.
        Linking primary care performance to outcomes of care.
        J Family Practice. 1998; 47: 213-220
        • Penman D.T.
        • Holland J.C.
        • Bahna G.F.
        • et al.
        Informed consent for investigational chemotherapy: patients' and physicians' perceptions.
        J Clin Oncol. 1984; 2: 849-855
        • Thom D.H.
        • Ribisl K.M.
        • Stewart A.L.
        • Luke D.A.
        Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians.
        Med Care. 1999; 37: 510-517
        • Safran D.G.
        • Montgomery J.E.
        • Chang H.
        • Murphy J.
        • Rogers W.H.
        Switching doctors: predictors of voluntary disenrollment from a primary physician's practice.
        J Family Practice. 2001; 50: 130-136
        • LaVeist T.A.
        • Nickerson K.J.
        • Bowie J.V.
        Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients.
        Med Care Res Rev. 2000; 57: 146-161
        • O'Malley A.S.
        • Sheppard V.B.
        • Schwartz M.
        • Mandelblatt J.
        The role of trust in use of preventive services among low-income African-American women.
        Prev Med. 2004; 38: 777-785
        • Armstrong K.
        • McMurphy S.
        • Dean L.T.
        • et al.
        Differences in the patterns of health care system distrust between blacks and whites.
        J Gen Intern Med. 2008; 23: 827-833
        • Hillen M.A.
        • Onderwater A.T.
        • van Zwieten M.C.B.
        • de Haes H.
        • Smets E.M.A.
        Disentangling cancer patients' trust in their oncologist: a qualitative study.
        Psycho-Oncol. 2012; 21: 392-399
        • Grosse Frie K.
        • van der Meulen J.
        • Black N.
        Relationship between patients' reports of complications and symptoms, disability and quality of life after surgery.
        Br J Surg. 2012; 99: 1156-1163
        • Bream E.
        • Black N.
        What is the relationship between patients' and clinicians' reports of the outcomes of elective surgery?.
        J Health Services Res Policy. 2009; 14: 174-182
        • McGee D.L.
        • Liao Y.
        • Cao G.
        • Cooper R.S.
        Self-reported health status and mortality in a multiethnic US cohort.
        Am J Epidemiol. 1999; 149: 41-46
        • Mossey J.M.
        • Shapiro E.
        Self-rated health: a predictor of mortality among the elderly.
        Am J Public Health. 1982; 72: 800-808
        • Macefield R.C.
        • Avery K.N.
        • Blazeby J.M.
        Integration of clinical and patient-reported outcomes in surgical oncology.
        Br J Surg. 2013; 100: 28-37