Best Case/Worst Case Framework Helps Surgeons Communicate With Frail Seriously Ill Patients

MedicalResearch.com Interview with:

Margaret L Schwarze, MD, MPP Associate Professor Division of Vascular Surgery University of Wisconsin

Dr. Margaret Schwarze

Margaret L Schwarze, MD, MPP
Associate Professor
Division of Vascular Surgery
University of Wisconsin

MedicalResearch.com: What is the background for this study?

Response: Surgery can have life-altering consequences for frail older adults, yet many undergo an operation during the last year of life. Surgeons commonly rely on informed consent to disclose risks of discrete complications; however, this information is challenging for patients to interpret with respect to their goals and values.

Our research group developed a communication framework, called Best Case/Worst Case, to change how surgeons communicate with patients facing serious illness.  Surgeons use the framework to describe the best, worst, and most likely scenarios to present a choice between valid treatment alternatives and help patients imagine how they might experience a range of possible treatment outcomes.

MedicalResearch.com: What are the main findings?

Response: We conducted a pre-post study to evaluate the proof of concept of an intervention to teach surgeons to use the Best Case/Worst Case framework. We audio recorded decision-making conversations between surgeons and frail, older adults with an acute surgical problem and analyzed the data using a mixed methods approach.

We found that after training, shared decision making improved on an objective measure.

Furthermore, these conversations improved such that after training surgeons focused on presenting a choice between treatments, described how a patient might experience treatment outcomes and engaged patients and families in deliberation.

MedicalResearch.com: What should readers take away from your report?

Response: Using Best Case/Worst Case changed how surgeons discussed difficult treatment decisions with older adults, shifting the focus from an isolated surgical problem to a conversation about treatment options and outcomes. Surgeons can use Best Case/Worst Case to engage patients and families in high-stakes decisions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future research should focus on determining a measurable health outcome to assess the clinical impact of this intervention beyond shared decision making. We are currently adapting the Best Case/Worst Case framework to help nephrologists talk to older patients about the decision to start dialysis and testing implementation of a group training program with surgical residents at institutions across the country.  We have also developed an instructional video to introduce the Best Case/Worst Case framework (https://www.youtube.com/watch?v=FnS3K44sbu0).

MedicalResearch.com: Is there anything else you would like to add?

Response: No disclosures, this was funded by the NIA – the GEMSSTAR program and the AGS and SVS, they had no role in the study. Also, the Cambia Foundation.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Taylor LJ, Nabozny MJ, Steffens NM, Tucholka JL, Brasel KJ, Johnson SK, Zelenski A, Rathouz PJ, Zhao Q, Kwekkeboom KL, Campbell TC, Schwarze ML. A Framework to Improve Surgeon Communication in High-Stakes Surgical DecisionsBest Case/Worst Case. JAMA Surg. Published online February 01, 2017. doi:10.1001/jamasurg.2016.5674

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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