Conversations about treatment preferences before high-risk surgery: a pilot study in the preoperative testing center.

Abstract

It is important to engage patients and surrogates in conversations about goals and preferences for medical treatment before high-risk surgery. However, few interventions have been tested to facilitate these discussions. To assess the acceptability and feasibility of a facilitated, structured conversation with patients and surrogates about patient goals and preferences for medical treatment during their visit to a preoperative testing center before high-risk surgery. A randomized controlled pilot study in the preoperative testing center at a tertiary academic hospital over a 4-month period. We used baseline and preoperative surveys to assess feasibility, and to compare differences in worry, surrogate burden, and patient-surrogate concordance about treatment preferences in conversation and control groups. We assessed acceptability of the conversation qualitatively and through surveys. Of 146 eligible patients, 79 were approached, and 65 declined to participate. Thirteen completed the study and 8 were randomized to the structured conversation. Major recruitment barriers included lack of time, or surrogate unavailability. Most postconversation patients were less worried, and more hopeful for a good recovery before surgery; 7 of 8 would recommend the conversation. Six of 8 surrogates reported postoperatively that the conversation helped prepare them to be a surrogate. Concordance improved in the intervention group only. Current processes of care present major barriers to conducting facilitated conversations in the preoperative testing center. Among a small group of patients and surrogates, most found a structured conversation about the patient's goals and preferences for medical treatment helpful before high-risk surgery.