Professional Abstract
Objective
To compare the effectiveness of using a question prompt list for surgical decisions versus not using one on improving patient engagement in the decision-making process, patient well-being, and postoperative treatment regret
Study Design
| Design Elements |
Description |
| Design |
Randomized time-dependent cluster randomized controlled trial |
| Population |
446 patients ages 60 and older considering surgery for oncologic or vascular conditions with one of 40 surgeons at 5 medical centers across the United States |
Interventions/
Comparators |
- Question prompt list
- Usual care
|
| Outcomes |
Number and type of questions asked during pre-surgical visit, patient-reported efficacy during interactions with physician, change in patient-reported well-being after treatment, patient-reported treatment regret |
| Timeframe |
Up to 14 weeks of follow-up for study outcomes |
This cluster-randomized stepped-wedge trial compared the effectiveness of a question prompt list versus usual care on improving patient engagement, well-being, and treatment regret for older patients considering surgery.
Researchers recruited 446 patients who were considering surgery for oncologic or vascular conditions and receiving care from 40 surgeons at five hospitals across the United States. Of these patients, 83% were white, 9% were black, 3% were Asian, 8% were another race, and 2% did not indicate a race; 17% were Hispanic or Latino. The average age was 72, and 56% were male.
Researchers randomized patients to one of two groups based on the timing of their visit with one of the participating surgeons. In the intervention group, patients received a brochure in the mail consisting of 11 questions to ask a surgeon when considering surgery. They also received a letter from their surgeon encouraging them to use the brochure during an upcoming surgical consultation. In the usual care group, patients did not receive a brochure or letter before their surgical consultation.
Researchers audio recorded the surgical consultation to count the number and type of questions patients asked. Patients also filled out a survey immediately after the visit to gauge their self-efficacy for obtaining information from the surgeon. Patients who underwent surgery completed a survey about well-being and treatment regret six weeks post-surgery. Patients who did not have surgery completed the survey 12–14 weeks after enrollment.
A group of older patients who had undergone major surgery and their family members helped create study materials, recruit study patients, interpret data, and share results.
Results
The two groups did not differ significantly in number or type of questions asked during the surgical consultation, or in patients’ well-being, treatment regret, or reported self-efficacy during interactions with physicians (all p<0.05).
Limitations
Only about half of patients in the intervention group read or used the list of questions, which may have affected the results.
Conclusions and Relevance
In this study, the list of questions did not improve older patients’ engagement in the decision-making progress, patient well-being, or patient regret about treatment.
Future Research Needs
Future research could examine how surgeon behavior can improve patient participation in decision making.
