BACKGROUND: It is important to engage patients and surrogates in conversations about goals and preferences for medical treatment before high-risk surgery. However, few interventions have been tested to facilitate these discussions. OBJECTIVE: To assess the acceptability and feasibility of a facilitated, structured conversation with patients and surrogates about patient goals and preferences for medical treatment during their visit to a preoperative testing center before high-risk surgery. DESIGN: A randomized controlled pilot study in the preoperative testing center at a tertiary academic hospital over a 4-month period. MEASUREMENTS: We used baseline and preoperative surveys to assess feasibility, and to compare differences in worry, surrogate burden, and patient-surrogate concordance about treatment preferences in conversation and control groups. We assessed acceptability of the conversation qualitatively and through surveys. RESULTS: Of 146 eligible patients, 79 were approached, and 65 declined to participate. Thirteen completed the study and 8 were randomized to the structured conversation. Major recruitment barriers included lack of time, or surrogate unavailability. Most postconversation patients were less worried, and more hopeful for a good recovery before surgery; 7 of 8 would recommend the conversation. Six of 8 surrogates reported postoperatively that the conversation helped prepare them to be a surrogate. Concordance improved in the intervention group only. CONCLUSIONS: Current processes of care present major barriers to conducting facilitated conversations in the preoperative testing center. Among a small group of patients and surrogates, most found a structured conversation about the patient's goals and preferences for medical treatment helpful before high-risk surgery.
RCT Entities:
BACKGROUND: It is important to engage patients and surrogates in conversations about goals and preferences for medical treatment before high-risk surgery. However, few interventions have been tested to facilitate these discussions. OBJECTIVE: To assess the acceptability and feasibility of a facilitated, structured conversation with patients and surrogates about patient goals and preferences for medical treatment during their visit to a preoperative testing center before high-risk surgery. DESIGN: A randomized controlled pilot study in the preoperative testing center at a tertiary academic hospital over a 4-month period. MEASUREMENTS: We used baseline and preoperative surveys to assess feasibility, and to compare differences in worry, surrogate burden, and patient-surrogate concordance about treatment preferences in conversation and control groups. We assessed acceptability of the conversation qualitatively and through surveys. RESULTS: Of 146 eligible patients, 79 were approached, and 65 declined to participate. Thirteen completed the study and 8 were randomized to the structured conversation. Major recruitment barriers included lack of time, or surrogate unavailability. Most postconversation patients were less worried, and more hopeful for a good recovery before surgery; 7 of 8 would recommend the conversation. Six of 8 surrogates reported postoperatively that the conversation helped prepare them to be a surrogate. Concordance improved in the intervention group only. CONCLUSIONS: Current processes of care present major barriers to conducting facilitated conversations in the preoperative testing center. Among a small group of patients and surrogates, most found a structured conversation about the patient's goals and preferences for medical treatment helpful before high-risk surgery.
Authors: Sushila Murthy; Justin T Clapp; Randall C Burson; Lee A Fleisher; Mark D Neuman Journal: J Am Geriatr Soc Date: 2022-01-06 Impact factor: 5.562
Authors: Janet Jull; Sascha Köpke; Maureen Smith; Meg Carley; Jeanette Finderup; Anne C Rahn; Laura Boland; Sandra Dunn; Andrew A Dwyer; Jürgen Kasper; Simone Maria Kienlin; France Légaré; Krystina B Lewis; Anne Lyddiatt; Claudia Rutherford; Junqiang Zhao; Tamara Rader; Ian D Graham; Dawn Stacey Journal: Cochrane Database Syst Rev Date: 2021-11-08
Authors: Ana C De Roo; Crystal Ann Vitous; Samantha J Rivard; Michaela C Bamdad; Sara M Jafri; Mary E Byrnes; Pasithorn A Suwanabol Journal: Surgery Date: 2021-03-10 Impact factor: 4.348
Authors: Rebecca A Aslakson; Sarina R Isenberg; Norah L Crossnohere; Alison M Conca-Cheng; Ting Yang; Matthew Weiss; Angelo E Volandes; John F P Bridges; Debra L Roter Journal: BMJ Open Date: 2017-06-06 Impact factor: 2.692
Authors: Anna Kata; Rebecca Sudore; Emily Finlayson; Jeanette M Broering; Sarah Ngo; Victoria L Tang Journal: J Am Geriatr Soc Date: 2018-10-05 Impact factor: 5.562