Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery

Abstract

Poor preoperative communication can have serious consequences, including unwanted treatment and postoperative conflict.OBJECTIVE To compare the effectiveness of a question prompt list (QPL) intervention vs usual care on patient engagement and well-being among older patients considering major surgery. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial used a stepped-wedge design to randomly assign patients to a QPL intervention (n = 223) or usual care (n = 223) based on the timing of their visit with 1 of 40 surgeons at 5 US study sites. Patients were 60 years or older with at least 1 comorbidity and an oncologic or vascular (cardiac, neurosurgical, or peripheral vascular) problem that could be treated with major surgery. Family members were also enrolled (n = 263). The study dates were June 2016 to November 2018. Data analysis was by intent-to-treat.INTERVENTIONS A brochure of 11 questions to ask a surgeon developed by patient and family stakeholders plus an endorsement letter from the surgeon were sent to patients before their outpatient visit. MAIN OUTCOMES AND MEASURESPrimary patient engagement outcomes included the number and type of questions asked during the surgical visit and patient-reported Perceived Efficacy in Patient-Physician Interactions scale assessed after the surgical visit. Primary well-being outcomes included (1) the difference between patient's Measure Yourself Concerns and Well-being (MYCaW) scores reported after surgery and scores reported after the surgical visit and (2) treatment-associated regret at 6 to 8 weeks after surgery. RESULTSOf 1319 patients eligible for participation, 223 were randomized to the QPL intervention and 223 to usual care. Among 446 patients, the mean (SD) age was 71.8 (7.1) years, and 249 (55.8%) were male. On intent-to-treat analysis, there was no significant difference between the QPL intervention and usual care for all patient-reported primary outcomes. The difference in MYCaW scores for family members was greater in usual care (effect estimate, 1.51; 95% CI, 0.28-2.74; P = .008). When the QPL intervention group was restricted to patients with clear evidence they reviewed the QPL, a nonsignificant increase in the effect size was observed for questions about options (odds ratio, 1.88; 95% CI, 0.81-4.35; P = .16), expectations (odds ratio, 1.59; 95% CI, 0.67-3.80; P = .29), and risks (odds ratio, 2.41; 95% CI, 1.04-5.59; P = .04) (nominal α = .01). CONCLUSIONS AND RELEVANCEThe results of this study were null related to primary patient engagement and well-being outcomes. Changing patient-physician communication may be difficult without addressing clinician communication directly.

%CRTFASTGEEPWR: a SAS macro for power of the generalized estimating equations of multi-period cluster randomized trials with application to stepped wedge designs

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Systematic review of patient-engagement interventions: potentials for enhancing person-centred care for older patients with multimorbidity

“…The study by Schwarze et al 31 measured the effect of a question prompt list (QPL) intervention versus usual care among older patients. The QPL intervention target informational needs of patients considering major surgery and include 11 questions that prompt patients and their family members to query their surgeon about treatment options, etc.…”

Information needs and development of a question prompt sheet for upper extremity vascularized composite allotransplantation: A mixed methods study

“…Effective communication entails a dialogue between provider and patient, and patient question-asking can increase patient engagement, empowerment, and the quality of provider information-giving ( Barnlund, 1970 ; Shepherd et al, 2011 ; Barton et al, 2020 ). However, patients commonly do not know what questions to ask to guide decision making ( Lopez-Vargas et al, 2014 ; Lederer et al, 2016 ; Schwarze et al, 2020 ). To date, no educational interventions have been developed to increase knowledge and understanding about UE VCA for people with UE amputations.…”