Despite giving their consent to surgery, many patients report feeling like they had no choice about whether to pursue surgery. They also often report feeling blindsided by the treatment and recovery process, and its impact on their lives. This is particularly problematic for older adults, where over-treatment occurs when surgery is performed to “fix” an identified “abnormality” without considering the patient’s overall health goals. These disparities are even more prominent in patients from groups that have been historically marginalized in the healthcare system. Division of Vascular Surgery Professor Dr. Gretchen Schwarze and Wisconsin Center for Education Research Associate Director Dr. Andrew Ruis hope to change this by shifting surgical informed consent conversations so they instead focus on the patient’s goals. With a new three-year, $600,000 Collaborative Health Sciences Program grant from the Wisconsin Partnership Program, they will train local and regional surgeons on Better Conversations, an evidence-based informed consent intervention.
“Better Conversations is intended to help surgeons better communicate with patients by clearly defining the goals of surgery — whether that is to help patients live longer, feel better, preserve function, or make a diagnosis. These goals are then compared with all the downsides of surgery, including the experience of treatment, major functional changes the patient could experience, and what are the chances that surgery falls short of our goals,” said Schwarze. “Our long-term goal is for every surgeon to use Better Conversations with every patient, every time so patients can receive treatment based on what matters to them. But we first need to provide evidence of an effective and scalable approach for training surgeons.”
Schwarze and Ruis plan to work with 60 surgeons at UW Health and the Medical College of Wisconsin who aim to learn Better Conversations. As part of the training process, they will compare two different methods for training the surgeons as they practice Better Conversations in their surgical consultations. The research team will also obtain feedback about Better Conversations from both the surgeons and their patients. Finally, they will explore the potential use of artificial intelligence (AI) to automate the feedback process to surgeons in the future. Experts will be gathered to determine ethical guidelines to ensure AI-generated feedback on surgical consultations can be done in a way that avoids systematic bias and preserves patient privacy and trust.
“The intent of Better Conversations is to improve health and health outcomes for all of our patients, and especially our vulnerable patients, by using a more accessible and beneficial consent process that will help patients understand the goals and downsides of surgery so they can make more informed decisions about how best to proceed,” said Schwarze. “This study will help us determine the most effective and acceptable methods for training surgeons on Better Conversations, so we can ultimately train them on a much broader scale in Wisconsin and beyond. We’re incredibly grateful to the Wisconsin Partnership Program for the funding that will make this possible.”