Engaging patients, health care professionals, and community members to improve preoperative decision making for older adults facing high-risk surgery

Nicole M. Steffens, Jennifer L. Tucholka, Michael J. Nabozny, Andrea E. Schmick, Karen Brasel, Margaret L. Schwarze

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Importance: Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery. Objective: To design an intervention to improve preoperative decision making and manage postoperative expectations. Design, Setting, and Participants: A Patient and Family Advisory Council (PFAC)was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison. Main Outcomes and Measures: Generation of a QPL to address patients' preoperative informational and decisional needs. Results: Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: "Should I have surgery?" "What should I expect if everything goes well?" and "What happens if things go wrong?" The final list included 11 questions within these domains, was understandable in English and Spanish, and was acceptable to patients in the clinic. Conclusions and Relevance: Through direct engagement of stakeholders, a QPL was created to address core decisional and informational needs of surgical patients. Future testing will evaluate whether this list can be used to improve patient engagement and reduce postoperative regret and conflict about postoperative treatments.

Original languageEnglish (US)
Pages (from-to)938-945
Number of pages8
JournalJAMA Surgery
Volume151
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Decision Making
Patient Care
Delivery of Health Care
Advance Care Planning
Advance Directives
Patient Participation
Ambulatory Care Facilities
Focus Groups
Libraries
Emotions

ASJC Scopus subject areas

  • Surgery

Cite this

Engaging patients, health care professionals, and community members to improve preoperative decision making for older adults facing high-risk surgery. / Steffens, Nicole M.; Tucholka, Jennifer L.; Nabozny, Michael J.; Schmick, Andrea E.; Brasel, Karen; Schwarze, Margaret L.

In: JAMA Surgery, Vol. 151, No. 10, 01.10.2016, p. 938-945.

Research output: Contribution to journalArticle

Steffens, Nicole M. ; Tucholka, Jennifer L. ; Nabozny, Michael J. ; Schmick, Andrea E. ; Brasel, Karen ; Schwarze, Margaret L. / Engaging patients, health care professionals, and community members to improve preoperative decision making for older adults facing high-risk surgery. In: JAMA Surgery. 2016 ; Vol. 151, No. 10. pp. 938-945.
@article{8e24405783af4616883f192532e2d779,
title = "Engaging patients, health care professionals, and community members to improve preoperative decision making for older adults facing high-risk surgery",
abstract = "Importance: Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery. Objective: To design an intervention to improve preoperative decision making and manage postoperative expectations. Design, Setting, and Participants: A Patient and Family Advisory Council (PFAC)was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison. Main Outcomes and Measures: Generation of a QPL to address patients' preoperative informational and decisional needs. Results: Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: {"}Should I have surgery?{"} {"}What should I expect if everything goes well?{"} and {"}What happens if things go wrong?{"} The final list included 11 questions within these domains, was understandable in English and Spanish, and was acceptable to patients in the clinic. Conclusions and Relevance: Through direct engagement of stakeholders, a QPL was created to address core decisional and informational needs of surgical patients. Future testing will evaluate whether this list can be used to improve patient engagement and reduce postoperative regret and conflict about postoperative treatments.",
author = "Steffens, {Nicole M.} and Tucholka, {Jennifer L.} and Nabozny, {Michael J.} and Schmick, {Andrea E.} and Karen Brasel and Schwarze, {Margaret L.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1001/jamasurg.2016.1308",
language = "English (US)",
volume = "151",
pages = "938--945",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "10",

}

TY - JOUR

T1 - Engaging patients, health care professionals, and community members to improve preoperative decision making for older adults facing high-risk surgery

AU - Steffens, Nicole M.

AU - Tucholka, Jennifer L.

AU - Nabozny, Michael J.

AU - Schmick, Andrea E.

AU - Brasel, Karen

AU - Schwarze, Margaret L.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Importance: Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery. Objective: To design an intervention to improve preoperative decision making and manage postoperative expectations. Design, Setting, and Participants: A Patient and Family Advisory Council (PFAC)was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison. Main Outcomes and Measures: Generation of a QPL to address patients' preoperative informational and decisional needs. Results: Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: "Should I have surgery?" "What should I expect if everything goes well?" and "What happens if things go wrong?" The final list included 11 questions within these domains, was understandable in English and Spanish, and was acceptable to patients in the clinic. Conclusions and Relevance: Through direct engagement of stakeholders, a QPL was created to address core decisional and informational needs of surgical patients. Future testing will evaluate whether this list can be used to improve patient engagement and reduce postoperative regret and conflict about postoperative treatments.

AB - Importance: Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery. Objective: To design an intervention to improve preoperative decision making and manage postoperative expectations. Design, Setting, and Participants: A Patient and Family Advisory Council (PFAC)was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison. Main Outcomes and Measures: Generation of a QPL to address patients' preoperative informational and decisional needs. Results: Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: "Should I have surgery?" "What should I expect if everything goes well?" and "What happens if things go wrong?" The final list included 11 questions within these domains, was understandable in English and Spanish, and was acceptable to patients in the clinic. Conclusions and Relevance: Through direct engagement of stakeholders, a QPL was created to address core decisional and informational needs of surgical patients. Future testing will evaluate whether this list can be used to improve patient engagement and reduce postoperative regret and conflict about postoperative treatments.

UR - http://www.scopus.com/inward/record.url?scp=84997541793&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84997541793&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2016.1308

DO - 10.1001/jamasurg.2016.1308

M3 - Article

VL - 151

SP - 938

EP - 945

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 10

ER -