Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery: A Multisite Randomized Clinical Trial

Margaret L. Schwarze, Anne Buffington, Jennifer L. Tucholka, Bret Hanlon, Paul J. Rathouz, Nicholas Marka, Lauren J. Taylor, Christopher J. Zimmermann, Anna Kata, Nathan D. Baggett, Daniel A. Fox, Andrea E. Schmick, Ana Berlin, Nina E. Glass, Anne C. Mosenthal, Emily Finlayson, Zara Cooper, Karen J. Brasel

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Abstract

Importance: Poor preoperative communication can have serious consequences, including unwanted treatment and postoperative conflict. Objective: To compare the effectiveness of a question prompt list (QPL) intervention vs usual care on patient engagement and well-being among older patients considering major surgery. Design, Setting, and Participants: This randomized clinical trial used a stepped-wedge design to randomly assign patients to a QPL intervention (n = 223) or usual care (n = 223) based on the timing of their visit with 1 of 40 surgeons at 5 US study sites. Patients were 60 years or older with at least 1 comorbidity and an oncologic or vascular (cardiac, neurosurgical, or peripheral vascular) problem that could be treated with major surgery. Family members were also enrolled (n = 263). The study dates were June 2016 to November 2018. Data analysis was by intent-to-treat. Interventions: A brochure of 11 questions to ask a surgeon developed by patient and family stakeholders plus an endorsement letter from the surgeon were sent to patients before their outpatient visit. Main Outcomes and Measures: Primary patient engagement outcomes included the number and type of questions asked during the surgical visit and patient-reported Perceived Efficacy in Patient-Physician Interactions scale assessed after the surgical visit. Primary well-being outcomes included (1) the difference between patient's Measure Yourself Concerns and Well-being (MYCaW) scores reported after surgery and scores reported after the surgical visit and (2) treatment-associated regret at 6 to 8 weeks after surgery. Results: Of 1319 patients eligible for participation, 223 were randomized to the QPL intervention and 223 to usual care. Among 446 patients, the mean (SD) age was 71.8 (7.1) years, and 249 (55.8%) were male. On intent-to-treat analysis, there was no significant difference between the QPL intervention and usual care for all patient-reported primary outcomes. The difference in MYCaW scores for family members was greater in usual care (effect estimate, 1.51; 95% CI, 0.28-2.74; P =.008). When the QPL intervention group was restricted to patients with clear evidence they reviewed the QPL, a nonsignificant increase in the effect size was observed for questions about options (odds ratio, 1.88; 95% CI, 0.81-4.35; P =.16), expectations (odds ratio, 1.59; 95% CI, 0.67-3.80; P =.29), and risks (odds ratio, 2.41; 95% CI, 1.04-5.59; P =.04) (nominal α =.01). Conclusions and Relevance: The results of this study were null related to primary patient engagement and well-being outcomes. Changing patient-physician communication may be difficult without addressing clinician communication directly. Trial Registration: ClinicalTrials.gov identifier: NCT02623335.

Original languageEnglish (US)
JournalJAMA Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Randomized Controlled Trials
Patient Participation
Odds Ratio
Communication
Blood Vessels
Physicians
Pamphlets
Comorbidity
Emotions
Outpatients
Outcome Assessment (Health Care)
Therapeutics
Surgeons

ASJC Scopus subject areas

  • Surgery

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Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery : A Multisite Randomized Clinical Trial. / Schwarze, Margaret L.; Buffington, Anne; Tucholka, Jennifer L.; Hanlon, Bret; Rathouz, Paul J.; Marka, Nicholas; Taylor, Lauren J.; Zimmermann, Christopher J.; Kata, Anna; Baggett, Nathan D.; Fox, Daniel A.; Schmick, Andrea E.; Berlin, Ana; Glass, Nina E.; Mosenthal, Anne C.; Finlayson, Emily; Cooper, Zara; Brasel, Karen J.

In: JAMA Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Schwarze, ML, Buffington, A, Tucholka, JL, Hanlon, B, Rathouz, PJ, Marka, N, Taylor, LJ, Zimmermann, CJ, Kata, A, Baggett, ND, Fox, DA, Schmick, AE, Berlin, A, Glass, NE, Mosenthal, AC, Finlayson, E, Cooper, Z & Brasel, KJ 2019, 'Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery: A Multisite Randomized Clinical Trial', JAMA Surgery. https://doi.org/10.1001/jamasurg.2019.3778
Schwarze, Margaret L. ; Buffington, Anne ; Tucholka, Jennifer L. ; Hanlon, Bret ; Rathouz, Paul J. ; Marka, Nicholas ; Taylor, Lauren J. ; Zimmermann, Christopher J. ; Kata, Anna ; Baggett, Nathan D. ; Fox, Daniel A. ; Schmick, Andrea E. ; Berlin, Ana ; Glass, Nina E. ; Mosenthal, Anne C. ; Finlayson, Emily ; Cooper, Zara ; Brasel, Karen J. / Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery : A Multisite Randomized Clinical Trial. In: JAMA Surgery. 2019.
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abstract = "Importance: Poor preoperative communication can have serious consequences, including unwanted treatment and postoperative conflict. Objective: To compare the effectiveness of a question prompt list (QPL) intervention vs usual care on patient engagement and well-being among older patients considering major surgery. Design, Setting, and Participants: This randomized clinical trial used a stepped-wedge design to randomly assign patients to a QPL intervention (n = 223) or usual care (n = 223) based on the timing of their visit with 1 of 40 surgeons at 5 US study sites. Patients were 60 years or older with at least 1 comorbidity and an oncologic or vascular (cardiac, neurosurgical, or peripheral vascular) problem that could be treated with major surgery. Family members were also enrolled (n = 263). The study dates were June 2016 to November 2018. Data analysis was by intent-to-treat. Interventions: A brochure of 11 questions to ask a surgeon developed by patient and family stakeholders plus an endorsement letter from the surgeon were sent to patients before their outpatient visit. Main Outcomes and Measures: Primary patient engagement outcomes included the number and type of questions asked during the surgical visit and patient-reported Perceived Efficacy in Patient-Physician Interactions scale assessed after the surgical visit. Primary well-being outcomes included (1) the difference between patient's Measure Yourself Concerns and Well-being (MYCaW) scores reported after surgery and scores reported after the surgical visit and (2) treatment-associated regret at 6 to 8 weeks after surgery. Results: Of 1319 patients eligible for participation, 223 were randomized to the QPL intervention and 223 to usual care. Among 446 patients, the mean (SD) age was 71.8 (7.1) years, and 249 (55.8{\%}) were male. On intent-to-treat analysis, there was no significant difference between the QPL intervention and usual care for all patient-reported primary outcomes. The difference in MYCaW scores for family members was greater in usual care (effect estimate, 1.51; 95{\%} CI, 0.28-2.74; P =.008). When the QPL intervention group was restricted to patients with clear evidence they reviewed the QPL, a nonsignificant increase in the effect size was observed for questions about options (odds ratio, 1.88; 95{\%} CI, 0.81-4.35; P =.16), expectations (odds ratio, 1.59; 95{\%} CI, 0.67-3.80; P =.29), and risks (odds ratio, 2.41; 95{\%} CI, 1.04-5.59; P =.04) (nominal α =.01). Conclusions and Relevance: The results of this study were null related to primary patient engagement and well-being outcomes. Changing patient-physician communication may be difficult without addressing clinician communication directly. Trial Registration: ClinicalTrials.gov identifier: NCT02623335.",
author = "Schwarze, {Margaret L.} and Anne Buffington and Tucholka, {Jennifer L.} and Bret Hanlon and Rathouz, {Paul J.} and Nicholas Marka and Taylor, {Lauren J.} and Zimmermann, {Christopher J.} and Anna Kata and Baggett, {Nathan D.} and Fox, {Daniel A.} and Schmick, {Andrea E.} and Ana Berlin and Glass, {Nina E.} and Mosenthal, {Anne C.} and Emily Finlayson and Zara Cooper and Brasel, {Karen J.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamasurg.2019.3778",
language = "English (US)",
journal = "JAMA Surgery",
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TY - JOUR

T1 - Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery

T2 - A Multisite Randomized Clinical Trial

AU - Schwarze, Margaret L.

AU - Buffington, Anne

AU - Tucholka, Jennifer L.

AU - Hanlon, Bret

AU - Rathouz, Paul J.

AU - Marka, Nicholas

AU - Taylor, Lauren J.

AU - Zimmermann, Christopher J.

AU - Kata, Anna

AU - Baggett, Nathan D.

AU - Fox, Daniel A.

AU - Schmick, Andrea E.

AU - Berlin, Ana

AU - Glass, Nina E.

AU - Mosenthal, Anne C.

AU - Finlayson, Emily

AU - Cooper, Zara

AU - Brasel, Karen J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Poor preoperative communication can have serious consequences, including unwanted treatment and postoperative conflict. Objective: To compare the effectiveness of a question prompt list (QPL) intervention vs usual care on patient engagement and well-being among older patients considering major surgery. Design, Setting, and Participants: This randomized clinical trial used a stepped-wedge design to randomly assign patients to a QPL intervention (n = 223) or usual care (n = 223) based on the timing of their visit with 1 of 40 surgeons at 5 US study sites. Patients were 60 years or older with at least 1 comorbidity and an oncologic or vascular (cardiac, neurosurgical, or peripheral vascular) problem that could be treated with major surgery. Family members were also enrolled (n = 263). The study dates were June 2016 to November 2018. Data analysis was by intent-to-treat. Interventions: A brochure of 11 questions to ask a surgeon developed by patient and family stakeholders plus an endorsement letter from the surgeon were sent to patients before their outpatient visit. Main Outcomes and Measures: Primary patient engagement outcomes included the number and type of questions asked during the surgical visit and patient-reported Perceived Efficacy in Patient-Physician Interactions scale assessed after the surgical visit. Primary well-being outcomes included (1) the difference between patient's Measure Yourself Concerns and Well-being (MYCaW) scores reported after surgery and scores reported after the surgical visit and (2) treatment-associated regret at 6 to 8 weeks after surgery. Results: Of 1319 patients eligible for participation, 223 were randomized to the QPL intervention and 223 to usual care. Among 446 patients, the mean (SD) age was 71.8 (7.1) years, and 249 (55.8%) were male. On intent-to-treat analysis, there was no significant difference between the QPL intervention and usual care for all patient-reported primary outcomes. The difference in MYCaW scores for family members was greater in usual care (effect estimate, 1.51; 95% CI, 0.28-2.74; P =.008). When the QPL intervention group was restricted to patients with clear evidence they reviewed the QPL, a nonsignificant increase in the effect size was observed for questions about options (odds ratio, 1.88; 95% CI, 0.81-4.35; P =.16), expectations (odds ratio, 1.59; 95% CI, 0.67-3.80; P =.29), and risks (odds ratio, 2.41; 95% CI, 1.04-5.59; P =.04) (nominal α =.01). Conclusions and Relevance: The results of this study were null related to primary patient engagement and well-being outcomes. Changing patient-physician communication may be difficult without addressing clinician communication directly. Trial Registration: ClinicalTrials.gov identifier: NCT02623335.

AB - Importance: Poor preoperative communication can have serious consequences, including unwanted treatment and postoperative conflict. Objective: To compare the effectiveness of a question prompt list (QPL) intervention vs usual care on patient engagement and well-being among older patients considering major surgery. Design, Setting, and Participants: This randomized clinical trial used a stepped-wedge design to randomly assign patients to a QPL intervention (n = 223) or usual care (n = 223) based on the timing of their visit with 1 of 40 surgeons at 5 US study sites. Patients were 60 years or older with at least 1 comorbidity and an oncologic or vascular (cardiac, neurosurgical, or peripheral vascular) problem that could be treated with major surgery. Family members were also enrolled (n = 263). The study dates were June 2016 to November 2018. Data analysis was by intent-to-treat. Interventions: A brochure of 11 questions to ask a surgeon developed by patient and family stakeholders plus an endorsement letter from the surgeon were sent to patients before their outpatient visit. Main Outcomes and Measures: Primary patient engagement outcomes included the number and type of questions asked during the surgical visit and patient-reported Perceived Efficacy in Patient-Physician Interactions scale assessed after the surgical visit. Primary well-being outcomes included (1) the difference between patient's Measure Yourself Concerns and Well-being (MYCaW) scores reported after surgery and scores reported after the surgical visit and (2) treatment-associated regret at 6 to 8 weeks after surgery. Results: Of 1319 patients eligible for participation, 223 were randomized to the QPL intervention and 223 to usual care. Among 446 patients, the mean (SD) age was 71.8 (7.1) years, and 249 (55.8%) were male. On intent-to-treat analysis, there was no significant difference between the QPL intervention and usual care for all patient-reported primary outcomes. The difference in MYCaW scores for family members was greater in usual care (effect estimate, 1.51; 95% CI, 0.28-2.74; P =.008). When the QPL intervention group was restricted to patients with clear evidence they reviewed the QPL, a nonsignificant increase in the effect size was observed for questions about options (odds ratio, 1.88; 95% CI, 0.81-4.35; P =.16), expectations (odds ratio, 1.59; 95% CI, 0.67-3.80; P =.29), and risks (odds ratio, 2.41; 95% CI, 1.04-5.59; P =.04) (nominal α =.01). Conclusions and Relevance: The results of this study were null related to primary patient engagement and well-being outcomes. Changing patient-physician communication may be difficult without addressing clinician communication directly. Trial Registration: ClinicalTrials.gov identifier: NCT02623335.

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