Surgical Psychology

Acute Care Surgery

Welcome to the home for the section of surgical psychology offered by the department of surgery's division of acute care surgery at the University of Florida College of Medicine – Jacksonville. The department provides professional services at UF Health Jacksonville, a tertiary care teaching hospital, which serves Northeast Florida and Southeast Georgia.

Patient Care

Our division provides patient care services specifically dedicated to treating the mental and emotional impacts of traumatic injury or other major physical maladies requiring surgical intervention. UF Health Surgical Psychology – Jacksonville employs two of our section’s licensed psychologist faculty and an additional psychology post-doctoral fellow.

Trauma Recovery

Trauma generally represents two interrelated components: a hazardous event that presents a threat to life goals and an inability of the person to respond with adequate coping mechanisms. Normal people experience normal reactions to a traumatic event. After a traumatic experience, an individual may notice various changes in their mood, behavior and body. Examples of these vary in intensity depending on the person and situation. The most common symptoms associated with trauma are changes in mood, appetite, sleep and energy level, motivation, concentration and focus, ability to do normal daily activities or work, and socialization. Practical assistance can be offered to children and adults by identifying the immediate need, clarifying that need, discussing an action plan and acting to address the need. This helps move an individual from immobility to mobility. A person may meet criteria for a mental health diagnosis when the person’s symptoms significantly affect their daily functioning and quality of life. Prevalent diagnoses after traumatic injury include acute stress disorder, post-traumatic stress disorder, anxiety disorders, depressive disorders and adjustment disorders. In addition, medications such as selective serotonin reuptake inhibitor, or SSRI, antidepressants are effective treatments for the symptoms of stress disorders. Our clinicians utilize evidenced-based psychological practice when providing services to patients and families at UF Health.

Identifying Older Patients At-Risk for Postoperative Delirium

Changes in cognition after anesthesia and surgery may occur in some older adults. Delirium seen in the postoperative period find the majority of patients recover shortly after surgery. However, postoperative delirium has persisted up to three months and, in some cases, longer in about half of older adults. While older age was identified as the most basic predisposing risk factors for ICU delirium, there have been other hypotheses offered to explain postoperative delirium. Among these are the type of surgery and the type of anesthetic used. Additional evidence points to the role of neuroinflammation, metabolic syndrome and the stress of surgery that impact a patient’s cognitive reserve. The functional status of older adults prior to surgery may offer additional guidance as to the level of the risk of postoperative delirium. Regardless of the underlying causes, cognitive changes following anesthesia and surgery that decrease functional independence and quality of life may lead to extended hospitalization and possible skilled nursing needs after discharge. The additional costs of such care only further burdens an already stressed health care system. The need for preoperative evaluation of cognition is imperative to reduce the risk of postoperative delirium among older adults. Thus, there is a need to screen older adults prior to surgery with a minimal burden on the staff or workflow of the organization.

Shared Decision Making

For the physician, the need to explain the risks and benefits of the different treatments offered requires effective communication. However, effective communication means ensuring that the patient comprehends the information while responding to expressed fears that may impede the processing of the information presented. The patient can also share her or his values with regard to quality of life issues that help guide a person’s decisions. In this way, a patient is encouraged to move from a passive recipient of information to an active participant in her own treatment in order to be more confident in the resulting treatment decisions. Health care providers are looking for innovative methods to provide quality health care to vulnerable populations while reducing disparities in communities with poor access to care and higher rates of disease and death based on race and ethnicity. A patient-centered approach treats the whole person and is responsive to patient values and perceptions of desirable outcomes. Thus, in a shared decision-making process, there is a distinct role for both the patient and provider that emphasizes the preferences and goals of the patient. The use of more patient-centered communication with underserved and vulnerable populations may also increase understanding, lead to better decisions and improve treatment adherence. In addition, to optimize the quality and outcomes of care, use of locally derived and culturally appropriate statistics that explain the effectiveness of various treatment options during a consultation may assist in the shared decision-making process and the best outcome for each patient.

Mild Cognitive Impairment and Late-Onset Depression

Cognitive decline in older adults may present as attention and concentration difficulties, slowed processing speed and executive dysfunction. The term pseudodementia sometimes gets mentioned as an explanation for cognitive decline in older adults. This term generally implies a depressed state is the underlying cause of cognitive impairment. However, this term is considered antiquated now with better understanding of the reasons for cognitive changes in later life. The more correct diagnosis is mild cognitive impairment. Instead of the cause, late-onset depression is likely a prodrome for dementia. Individuals with late life depression are prone to be diagnosed with dementia within a few years. It was found that the combination of impaired cognitive and depressive symptoms doubles for every five-year increase in age after 70 and is present in 25% of 85-year olds. Neuroimaging shows both deep subcortical grey and white matter lesions suggestive of a cerebrovascular disease plus cognitive impairment. A better model is depression with memory impairment and executive dysfunction. Thus, the presence of depression should not be an exclusion for the diagnosis of dementia. Moreover, there are treatments available for both depression and mild cognitive impairment if identified early.

Conducting a Family Conference

When communicating "bad" news to patients, the following six-step protocol can be useful to guide a family conference. The six steps are to prepare and plan beforehand, find out how much the family knows, then ask how much does the family want to know, share the information, be responsive to the family’s feelings and plan to follow-up.

  1. First, prepare yourself and plan what will be discussed by confirming the facts and rehearsing what will be shared. Choose an appropriate setting that is a quiet, private place, allot adequate time, and decide who will attend the meeting and who will lead the meeting.
  2. Next, establish what the family understands so far about the illness and discuss goals and expectations that can be hoped for and the patient wants.
  3. Before you share any news, ask if the family is ready to hear about the results and establish how much information is wanted. Seek comfort goals and keep the patient as comfortable as possible. Ask if it would it be helpful to discuss prognosis and speak in ranges rather than specifics while balancing hope and realism.
  4. Use clear, comprehensible language and give the information in small pieces keeping to only one or two key points.
  5. Then, stop and wait. Be prepared for a range of emotions and listen with a caring attitude. Acknowledge the emotions and provide support.
  6. Finally, end the meeting by summarizing decisions made using clear language and reassuring the family that the patient will not be abandoned.

Research

Development and implementation of various research projects conducted in the section of surgical psychology focus upon the many opportunities for improvements in the well-being and quality of life of critically ill patients.

Dr. Brian Celso

  • Social determinates of health care disparities
  • Post-operative delirium
  • Resiliency

Dr. Kamela Scott

  • Adolescent violence prevention
  • Suicide prevention
  • Traumatic Brain Injury
  • Collaborative care

In addition to participation in research, faculty play an important role in training residents and fellows in the area of research.

For more information about the ongoing research at the University of Florida Health Science Center Jacksonville, please visit our research page.

Faculty

Contact Us

For information on the University of Florida College of Medicine – Jacksonville division of acute care surgery, please contact:

Address

Division of Acute Care Surgery
UF College of Medicine – Jacksonville
655 West 8th Street, FC12
8th Floor, Clinical Center
Jacksonville, FL 32209