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J Am Geriatr Soc. 2015 Sep;63(9):1805-11. doi: 10.1111/jgs.13615. Epub 2015 Aug 17.

"Best Case/Worst Case": Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions.

Author information

1
Department of Medicine, Northwestern University, Chicago, Illinois.
2
Department of Surgery, University of Wisconsin, Madison, Wisconsin.
3
Department of Surgery, Oregon Health & Science University, Portland, Oregon.
4
Department of Medicine, University of Wisconsin, Madison, Wisconsin.
5
Center for Patient Partnerships, University of Wisconsin Law School, Madison, Wisconsin.
6
Department of Medical History and Bioethics, University of Wisconsin, Madison, Wisconsin.

Abstract

OBJECTIVES:

To evaluate a communication tool called "Best Case/Worst Case" (BC/WC) based on an established conceptual model of shared decision-making.

DESIGN:

Focus group study.

SETTING:

Older adults (four focus groups) and surgeons (two focus groups) using modified questions from the Decision Aid Acceptability Scale and the Decisional Conflict Scale to evaluate and revise the communication tool.

PARTICIPANTS:

Individuals aged 60 and older recruited from senior centers (n = 37) and surgeons from academic and private practices in Wisconsin (n = 17).

MEASUREMENTS:

Qualitative content analysis was used to explore themes and concepts that focus group respondents identified.

RESULTS:

Seniors and surgeons praised the tool for the unambiguous illustration of multiple treatment options and the clarity gained from presentation of an array of treatment outcomes. Participants noted that the tool provides an opportunity for in-the-moment, preference-based deliberation about options and a platform for further discussion with other clinicians and loved ones. Older adults worried that the format of the tool was not universally accessible for people with different educational backgrounds, and surgeons had concerns that the tool was vulnerable to physicians' subjective biases.

CONCLUSION:

The BC/WC tool is a novel decision support intervention that may help facilitate difficult decision-making for older adults and their physicians when considering invasive, acute medical treatments such as surgery.

KEYWORDS:

acute care surgery; communication tool; palliative care; shared decision-making

PMID:
26280462
PMCID:
PMC4747100
DOI:
10.1111/jgs.13615
[Indexed for MEDLINE]
Free PMC Article

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