Engaging Patients, Health Care Professionals, and Community Members to Improve Preoperative Decision Making for Older Adults Facing High-Risk Surgery
Engaging Patients, Health Care Professionals, and Community Members to Improve Preoperative Decision Making for Older Adults Facing High-Risk Surgery
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DOI：
10.1001/jamasurg.2016.1308
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发表时间：
2016-10-01
期刊：
影响因子：
16.9
通讯作者：
Schwarze, Margaret L.
中科院分区：
文献类型：
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作者：
Steffens, Nicole M.;Tucholka, Jennifer L.;Schwarze, Margaret L.
重要性老年患者术后并发症的风险更大，但他们不太可能比年轻的患者问的问题surgery.Objective设计干预，以改善术前决策和管理术后expectations.DESIGN，设置，和参与者一个病人和家庭咨询理事会（PFAC）创建，以帮助确定术前决策的需求。PFAC包括4名男性和女性，他们之前曾作为老年患者或其家庭成员接受过高风险手术; PFAC从2014年5月至2015年4月每月在当地图书馆开会，以检查之前定性研究的结果，并将主题与PFAC成员的经验相结合。患者观察包括患者和外科医生之间的91次谈话记录和手术前后的61次患者访谈。PFAC成员和其他利益相关者评估了118个公开可用的问题，并选择了12个对应于已确定的需求的问题，以生成问题提示列表（QPL）。在威斯康星州的麦迪逊和密尔沃基的社区中心进行了三个焦点小组，包括来自不同背景的31名社区成员，以完善QPL。一个临床试点与42例患者考虑手术进行了一个门诊外科诊所在麦迪逊。主要结果和措施生成的QPL，以解决患者的术前信息和决策needs. ResultsThrough定性数据的探索，PFAC指出3个关键问题。患者和家属认为必须进行手术，对术后恢复的困难感到惊讶，并且缺乏关于围手术期使用预先指令的知识。PFAC确定了在术前对话期间需要更多信息和决策支持，包括澄清治疗方案、设定术后期望和提前护理计划。出现了以下3个问题提示类别：“我应该做手术吗？”“如果一切顺利，我应该期待什么呢？如果事情出了差错怎么办？“最终的清单包括11个问题，在这些领域，是可以理解的英语和西班牙语，是可以接受的病人在clinic.CONCLUSIONS和相关性通过直接参与的利益相关者，创建一个QPL，以解决核心的决策和信息需求的手术患者。未来的测试将评估该列表是否可用于改善患者参与度，减少术后遗憾和术后治疗冲突。
IMPORTANCE Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery.OBJECTIVE To design an intervention to improve preoperative decision making and manage postoperative expectations.DESIGN, SETTING, AND PARTICIPANTS A Patient and Family Advisory Council (PFAC) was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison.MAIN OUTCOMES AND MEASURES Generation of a QPL to address patients' preoperative informational and decisional needs.RESULTS Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: "Should I have surgery?" "What should I expect if everything goes well?" and "What happens if things go wrong?" The final list included 11 questions within these domains, was understandable in English and Spanish, and was acceptable to patients in the clinic.CONCLUSIONS AND RELEVANCE Through direct engagement of stakeholders, a QPL was created to address core decisional and informational needs of surgical patients. Future testing will evaluate whether this list can be used to improve patient engagement and reduce postoperative regret and conflict about postoperative treatments.