WBB's Thought Leadership

Pre-Operative Questions May Improve Surgical Decision Making for Older Adults

March 7


Research shows question prompt lists (QPLs) could help improve patient engagement and reduce postoperative treatment regret and conflict about additional treatments.

Excerpt: “About 500,000 Americans aged 65 and older will have a high-risk operation, such as heart bypass or major cancer surgery, each year.”

“Surgeons play an important role helping patients make preference-sensitive decisions, but they can sometimes miss opportunities to have these discussions. … Studies indicate that patients actively engaged in the decision-making process are more likely to receive patient-focused care. This activation is especially important for older patients because they tend to be less likely to ask questions and are less effective in ensuring that physicians attend to their concerns.

“In previous research, standardized question prompt lists (QPLs) have been shown to effectively improve patient engagement in other setting. Several QPL tools are available, but Dr. Schwarze says greater efforts are needed to improve patient engagement in surgical decision making. ‘We need to bridge the gap between patients’ needs to make the consequences of surgery relevant to their lives and surgeons’ goals of setting realistic expectations,’ she says.”

“For a study published in JAMA Surgery, Dr. Schwarze and colleagues designed a preoperative decision making intervention to generate a QPL. The authors formalized a partnership with patients, family members, and researchers, collaborating with their Patient and Family Advisory Council (PFAC) to develop a QPL to help older adults with high-stakes surgical decisions. The PFAC included four men and women who had previous experience with high-risk surgery as older patients or their family members. The group met monthly to examine findings from a prior study of surgeon-patient communication and to integrate themes with members’ experiences.

“In total, the research team observed 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. PFAC members and other stakeholders evaluated 118 publicly available questions and selected 11 that specifically corresponded to their needs in order to generate a QPL.

“‘Our study revealed that patients believed that the need for surgery was absolute, were surprised that postoperative recovery was difficult, and lacked knowledge about perioperative advance care planning,’ says Dr. Schwarze. The PFAC identified a need for more information and decisional support during preoperative conversations. Several specific areas were identified, including clarifying treatment options, establishing postoperative expectations, and addressing advance care plans.”

Source: Physician's Weekly

WBB Take: To reduce the high number of medical errors resulting in missed opportunities, injury, and premature death, healthcare providers need to use basic quality improvement principles. Likewise, quality improvement techniques can help align patient expectations and most probable medical outcomes. A core principle of Lean Six Sigma is the inclusion of the Voice of the Customer (VoC). In healthcare, VoC implies inclusion of the patient, their caregivers, and patient families in the development and execution of the careflow, and in making medical decisions. Various studies have shown that including patients in the overall quality processes increased patient satisfaction, and reduced cost and risk. Participation by patients in the preoperative decision-making process can reduce risk of errors, increase patient understanding of surgical outcomes, and avoid patient dissatisfaction with surgical results.

Jessica Say

Jessica Say



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