"Best Case/Worst Case": Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions.
OBJECTIVE
To evaluate a communication tool called "Best Case/Worst Case" (BC/WC) based on an established conceptual model of shared decision-making.


METHODS
Focus group study.


METHODS
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.


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


METHODS
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.


CONCLUSIONS
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.
Department of Medicine, Northwestern University, Chicago, Illinois.
Jacqueline M
JM
Kruser
Department of Surgery, University of Wisconsin, Madison, Wisconsin.
Michael J
MJ
Nabozny
Department of Surgery, University of Wisconsin, Madison, Wisconsin.
Nicole M
NM
Steffens
Department of Surgery, Oregon Health & Science University, Portland, Oregon.
Karen J
KJ
Brasel
Department of Medicine, University of Wisconsin, Madison, Wisconsin.
Toby C
TC
Campbell
Center for Patient Partnerships, University of Wisconsin Law School, Madison, Wisconsin.
Martha E
ME
Gaines
Department of Surgery, University of Wisconsin, Madison, Wisconsin.|Department of Medical History and Bioethics, University of Wisconsin, Madison, Wisconsin.
Margaret L
ML
Schwarze
D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D003142:Communication; D005069:Evaluation Studies as Topic; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010820:Physicians; D013514:Surgical Procedures, Operative
acute care surgery; communication tool; palliative care; shared decision-making