Shared decision-making: Use questions to better inform surgical patients

Researchers and surgeons at the University of Wisconsin School of Medicine and Public Health Department of Surgery have developed a list of question prompts to better inform and engage with surgical patients, especially those 65 and older who may face greater risk from invasive procedures.

The process, detailed in JAMA Surgery, began with the creation of a Patient and Family Advisory Council, which would review previous study data on surgical patient engagement to help determine where preoperative decision making was lacking, and would review research as the study team completed it to provide feedback. During this process--which took a year, according to the study--the council found three critical issues: patients and family members in the data sets believed that surgery “had to be done,” they were surprised when recovery after the procedure was difficult and they often lacked needed information on preoperative use of advanced directives.

Those discussions, the study noted, led to three key questions patients needed to have answered: “Should I have surgery?” “What should I expect if everything goes well?” and “What happens if things go wrong?” The study team then expanded that list to 11 questions, all in a similar vein, that patients can use to better understand the surgical process.

Once the question prompt list was tentatively formed, the study team piloted it with 42 patients in a Madison, Wisconsin, clinic, according to the team. The team distilled the questions into a brochure that patients were offered. According to the study, the pilot patients noted that having the list gave them “questions (they) would never have thought to ask." The pilot group was small, though, so the team said further investigation is needed to truly prove the efficacy of the measure.

The team noted that similar shared decision-making aids to exist, but patients are not always involved in their development. “To improve patient engagement in surgical decision making, we need to bridge the gap between patients’ need to make the consequences of surgery relevant to their lives and the surgeon’s goal of setting realistic expectations,” they wrote.

- read the study