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Navigating high-risk surgery: empowering older adults to ask questions that inform decisions about surgical treatment
Investigator (PI): Schwarze, Margaret
Performing Organization (PO): (Current): University of Wisconsin-Madison, School of Medicine and Public Health, Department of Surgery, Division of Vascular Surgery / (608) 265-4420
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2020
Record Source/Award ID: PCORI/CDR-1502-27462
Funding: Total Award Amount: $2,110,000
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: Each year, more than 500,000 older Americans consider major surgery, such as a vascular bypass or a complex cancer operation. These are very complicated decisions with potentially far-reaching consequences; although older patients can benefit from these risky operations, they are also more likely to face serious complications that result in intensive care stays, lengthy hospitalizations, or long-term confinement in a nursing home. Patients have reported being "blindsided" by these outcomes, which places substantial burdens on them and their families. Older patients need to fully understand their treatment options in the context of their values and preferences so they can decide if high-risk surgery is right for them. Unfortunately, the way surgeons and patients currently communicate impedes this decision-making process. Surgeons focus on risk disclosure as required by informed consent guidelines and struggle to describe the outcomes of surgery in a way that is relevant to patients. Patients may want to participate in decision making, but find it hard to ask the questions that might help them best understand what surgery might mean for them. We aim to close the gap between what surgeons know and what patients understand by empowering patients and family members to ask questions about how high-risk surgery can affect "people like me." One proven way to do this is to provide patients with a question list (called a "question prompt list" [QPL]) before they come to the clinic to discuss the possibility of surgery. We collaborated with patients and family members who have lived experience with high-risk surgery to adapt existing questions into a QPL that aims to better meet the needs of older people considering high-risk surgery. Methods: In partnership with patient and family advisors and health care stakeholders, we will conduct a study to compare our QPL with usual care. Participants will be patients aged 65 and over who have other health problems and who are considering a high-risk vascular or cancer surgery. We will enroll a total of 480 patients (240 in the intervention arm and 240 in the usual care arm) in five US cities: Madison, Wisconsin; Boston, Massachusetts; Newark, New Jersey; San Francisco, California; and Portland, Oregon. Patients in the intervention arm will receive the QPL and a letter from their surgeon encouraging its use before they meet with the surgeon; patients in the usual care arm will receive the current standard for decision making. Outcomes: Using data collected from patient interviews and surveys administered before and after surgery, we hope to show that the QPL intervention increases patient participation in decision making, increases patient and family member well-being, reduces post-treatment regret, and decreases post-treatment conflict. If the intervention is found superior, our long-term goal is to incorporate it into the care of all older adults considering major surgery.
MeSH Terms:
  • Aged
  • Boston
  • Communication
  • Decision Making
  • Guidelines as Topic
  • Hospitalization
  • Humans
  • Length of Stay
  • Neoplasms /surgery
  • New Jersey
  • Oregon
  • Patient Education as Topic /*methods
  • Professional-Patient Relations
  • Risk
  • San Francisco
  • Surgical Procedures, Operative /*methods
  • Truth Disclosure
  • Vascular Surgical Procedures /methods
  • Wisconsin
Country: United States
State: Wisconsin
Zip Code: 53792
UI: 20162026
Project Status: Ongoing
Record History: ('2017: Project extended to 2020.',)