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Surgical Question Prompt List Intervention

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About the Surgical Question Prompt List intervention

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.  Question prompt lists have proven efficacy in other settings and aim to empower patients to ask questions so they can play a more active role in treatment decision making.

To help bridge this gap and address core decisional and informational needs of surgical patients, researchers at the University of Wisconsin – Madison recruited patients and family members of patients who had high-risk surgery, health care professionals, and community members to develop a Surgical Question Prompt List intervention.

What does this Surgical Question Prompt List intervention contain?

This intervention contains two items:

  1. A brochure with 11 questions to ask a surgeon during conversations about treatment.
  2. A letter from the surgeon encouraging its use, that can be modified to fit the needs of the surgical clinic or setting.

These items are available in the both the English and Spanish languages.

Who should use this Surgical Question Prompt List intervention?

This Question Prompt List intervention is intended for use by (1) surgical clinics and (2) their patients. 

How should this Surgical Question Prompt List intervention be used?

So patients can fully read and thoughtfully consider the list of questions, the Surgical Question Prompt List intervention (brochure and letter) should be sent to patients via US mail several days before they meet the surgeon to discuss treatment options.

To be effective, QPL interventions require physicians to endorse and support the patient’s use of the question list, but they do not require patient navigators or patient coaching. Surgeons and their clinical staff may modify the letter as long as it encourages the use of the questions on the list.

We ask that you do not modify the Surgical Question Prompt List itself, although some clinics may prefer to change the word “surgery” to “procedure” or “treatment” given that many surgeons perform interventions that are not typically described as surgery (e.g., angioplasty, endoscopy). This version is available upon request.

Development of the Surgical Question Prompt List intervention

The Surgical Question Prompt List intervention was developed by researchers and surgeons (Principal Investigator: Margaret (Gretchen) L. Schwarze) in the Wisconsin Surgical Outcomes Research Program (WiSOR) at the University of Wisconsin – Madison.

They developed the Surgical Question Prompt List intervention with assistance from an advisory council of patients and family members who had lived experience with major surgery. The council identified a need for better decisional support during preoperative conversations, including discussion of treatment options, postoperative expectations and advance care planning.

Specifically, they proposed three question categories:

  • “Should I have surgery?”
  • “What should I expect if everything goes well?”
  • “What happens if things go wrong?”

They then adapted existing question lists to better meet the needs of patients considering high-risk surgery. The questions on the Surgical Question Prompt List are designed to empower patients to ask about — and deliberate on — the broader outcomes of surgery.  Because the questions come from patients themselves, they can empower patients and family members to access the information they need in a way they will understand.

Future research will evaluate whether the question list helps older patients make decisions aligned with their values and goals, enables them to anticipate and make sense of the outcomes of surgery, and reduces conflict between patients and surgeons if complications occur after surgery. The research team has received funding from the Patient-Centered Outcomes Research Institute to test the Surgical Question Prompt List intervention in a randomized controlled trial.

Funding for the Surgical Question Prompt List intervention

This study was supported by training award  KL2TR000428 of the Clinical and Translational Science Award program (Dr Schwarze) as part of grant UL1TR000427 to the Institute for Clinical and Translational Research (ICTR), University of Wisconsin, from the National Institutes of Health, National Center for Advancing Translational Sciences; by grant 3086 from the ICTR, through the University of  Wisconsin School of Medicine and Public Health’s Wisconsin Partnership Program (Dr Schwarze); by the Greenwall Foundation Kornfield grant; by grant 5P60MD003428 from the National Institute for  Minority Health and Health Disparities Center of Excellence program through the University of Wisconsin Collaborative Center for Health Equity; and by award CDR-1502-27462 from the Patient-Centered Outcomes Research Institute (PCORI).

These funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript.

The statements in this introduction and the associated manuscript are solely the responsibility of the authors and do not necessarily represent the views of the National Institutes of Health, PCORI, its board of governors, or its methodology committee, or other funders.

The methodology used to develop this intervention is available in the following article: Steffens NM, Tucholka JL, Nabozny MJ, Schmick AE, Brasel KJ, Schwarze ML. Engaging Patients, Health Care Professionals, and Community Members to Improve Preoperative Decision Making for Older Adults Facing High-Risk Surgery. JAMA Surgery. 2016; in press.

Citation: If you decide to use these materials, we ask that you please cite the above article, and use the following citation for this toolkit: Wisconsin Surgical Outcomes Research Program (WiSOR). Surgical Question Prompt List Intervention. University of Wisconsin – Madison Department of Surgery, the UW Institute for Clinical and Translational Research, and the UW Health Innovation Program; 2016. Available at: https://hipxchange.org/SurgicalQPL.