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Current Studies

Navigating Major Surgery

Best Case/Worst Case

Navigating Major Surgery

Our team is piloting a question prompt list (QPL) that older patients can use in preoperative discussions with a surgeon. The QPL is formatted as a three-panel printed brochure.

Outside of QPL brochure

Inside of QPL brochure

We developed the QPL with 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?”


Question categories and goals

We then adapted existing question lists to better meet the needs of patients considering high-risk surgery. The questions on our QPL are designed to empower patients to ask about — and deliberate on — the broader outcomes of surgery, not just individual risks or complications.

Future research will evaluate whether the question list helps older patients make decisions in line 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.

We have received funding from the Patient-Centered Outcomes Research Institute (PCORI) to continue this work.

Funding acknowledgement: This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CDR-1502-27462).

Disclaimer: All statements in this webpage are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.

Best Case/Worst Case

Our team is evaluating a communication tool that structures the decision-making conversation between patients and surgeons. The tool is a simple pen-and-paper graphic that the surgeon draws during that conversation.

The best case/worst case graphic framework

Each vertical line represents a different treatment choice; for example, surgery vs. medical management, or surgery vs. supportive care.

The star at the top of each line represents the “best-case scenario,” the box at the bottom represents the “worst-case scenario,” and the oval represents the “most likely scenario.”

The surgeon provides narratives about what the patient’s life would look like for the best- and worst-case scenarios. He or she then incorporates evidence and knowledge of the patient’s clinical condition to estimate the most likely outcome, interpret it for patients, and encourage deliberation.

Currently, we are teaching surgeons to learn to use the tool, assessing whether the tool is feasible to use with patients in a clinical setting, and optimizing recruitment and data gathering procedures for a future study. Copyright © 2017 The Board of Regents of the University of Wisconsin System