National Study Goal: Help Surgery Patients Ask Better Questions

A three-year study, which gives patients a better way to talk to their surgeon, has earned a $2.1 million grant from the Patient-Centered Outcomes Research Initiative (PCORI).

Dr. Margaret Schwarze of the University of Wisconsin-Madison, is believed to be the first member of the Society for Vascular Surgery to be the principal investigator of a PCORI grant.

“Navigating High Risk Surgery: Empowering Older Adults to Ask Questions that Inform Decisions about Surgical Treatment” is a three-year study that began Jan. 1, 2016 and will enroll its first patients this summer. Five sites will participate: Brigham and Women’s Hospital, Boston; University of California-San Francisco; Rutgers University, Oregon Health Sciences University, Portland, Oregon; and UW-Madison.  

“We are very proud that one of our members has been awarded a prestigious PCORI grant,” said Dr. Bruce A. Perler, president of the Society for Vascular Surgery, “not only because these are coveted, high profile awards, but because Dr. Schwarze’s patient-focused research speaks to the heart of our mission to promote the highest quality and most appropriate patient care.”

The study will have 480 patients aged 65 or older, who have other health problems and are considering high risk vascular or cancer surgery. Using patient interviews and before/after surveys, researchers hope to show that using a specific questioning process  increases patient participation in decision making, increases patient and family member well-being, reduces post-treatment regret and decreases post-treatment conflict.

Patients in the study will receive a brochure from their doctor’s office with a short list of questions to ask at their next visit. The questions range from what might happen if the patient opts out of surgery, to how the patient can arrange advance directives, if desired.

“Surgeons are great about talking about the risks of heart attack or being in ICU,” Schwarze noted, “but may not focus on what else is of keen interest to the patient. Patients may want to participate in the decision to have surgery, but they don’t know what questions to ask that will help them understand whether surgery is right for them or what it might be like after surgery.”

She described one elderly woman who had heart valve surgery based on the advice of her surgeon. Because she didn’t ask the right questions, although she had been well informed about complications, she was stunned and very frightened that she was so fatigued afterward.

“So many patients are blindsided by side effects or outcomes of surgery that they never anticipated,” explained Dr. Schwarze, “and others had advance directives that did not get communicated to all medical personnel. “

Dr. Schwarze recruited patients and family member to assist her as research partners. “It completely changed the way I think about this,” said Dr. Schwarze. “I had not involved patients directly in my research at this level before. I learned things I never expected.”

For example, she learned that prior to surgery, patients had fears that they never shared with their surgeon.

“Typically patients ask things like, ‘Can my wife stay in the room with me?’ or ‘Will I be able to wash my hair?’” she said. “But there are other types of questions people should ask, such as, will the surgery do what I want it to do? We aim to close the gap between what surgeons know and what patients understand by empowering patients and family members to ask questions about how high-risk surgery can affect ‘people like me.’”

Some patients also have out-of-reach expectations, Dr. Schwarze said. As an example, she has found that though a carotid endarterectomy is done to prevent stroke, many patients presume that it also will improve their memory or stop their ears from ringing.

“When they consent to surgery, they should do it for the right reasons,” she said, “and not some fantasy about what surgery can do.”

Learn more about the PCORI study at http://vsweb.org/PCORIsurgeryquestions.

 

Photo caption: Vascular surgeon Dr. Margaret Schwarze of the University of Wisconsin-Madison, talks with a patient. Dr. Schwarze recently won a prestigious PCORI grant to study how patients ask questions before surgery.  Photo courtesy of the University of Wisconsin-Madison.

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The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for more than 5,300 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease. The Society is headquartered in Chicago, Illinois. Visit www.vascularweb.org or email Kay Severinsen, assistant director/communications, at kseverinsen@vascularsociety.org.