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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 9 of 9 Research Studies DisplayedKim KM, Giannitrapani KF, Garcia A
Patient characteristics associated with occurrence of preoperative goals-of-care conversations.
This study’s goal was to evaluate the association between patient risk of hospitalization or death and goals-of-care conversations documented with a completed Life-Sustaining Treatment (LST) Decisions Initiative note among veterans undergoing surgery. This retrospective cross-sectional study included 190,040 veterans who underwent operations between January 2017 and February 2020. The main outcome looked at was preoperative LST note completion (30 days before or on the day of surgery) or no LST note completion within the 30-day preoperative period prior to or on the day of the index operation. Of 190,040 veterans (90.8% men), 3.8% completed an LST note before surgery, and 96.2% did not complete an LST note. In the groups with and without LST note completion before surgery, most were aged between 65 and 84 years, male, and Whites. Compared with patients who completed an LST, patients who did not tended to be female, married, Black, and in better health; to have a lower risk of hospitalization or death; or to undergo neurosurgical or urologic surgical procedures. Over the 3-year study interval, unadjusted rates of LST note completion before surgery increased from 0.1% to 9.6%. High-risk surgery was not associated with increased LST note completion before surgery. Veterans who underwent cardiothoracic surgery had the highest likelihood of LST note completion before surgery.
AHRQ-funded; F32 HS028747.
Citation: Kim KM, Giannitrapani KF, Garcia A .
Patient characteristics associated with occurrence of preoperative goals-of-care conversations.
JAMA Netw Open 2023 Feb;6(2):e2255407. doi: 10.1001/jamanetworkopen.2022.55407.
Keywords: Surgery, Clinician-Patient Communication, Communication
Links AR, Callon W, Wasserman C
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. In this study, the authors characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. The investigators concluded that clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions.
AHRQ-funded; HS022932.
Citation: Links AR, Callon W, Wasserman C .
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
Patient Educ Couns 2021 Jun;104(6):1371-79. doi: 10.1016/j.pec.2020.11.015..
Keywords: Children/Adolescents, Surgery, Caregiving, Shared Decision Making, Clinician-Patient Communication, Communication, Provider: Physician, Provider
McGovern KM, Wells EE, Landstrom GL
Understanding interpersonal and organizational dynamics among providers responding to crisis.
Patient rescue occurs in phases: recognizing the problem, communicating the concern, and treating the complication. To help improve rescue, the investigators sought to understand facilitators and barriers to managing postoperative complications, using a criterion-based sample from a large academic medical center. The study identified significant variation in communication processes across providers caring for surgical patients.
AHRQ-funded; HS024403.
Citation: McGovern KM, Wells EE, Landstrom GL .
Understanding interpersonal and organizational dynamics among providers responding to crisis.
Qual Health Res 2020 Feb;30(3):331-40. doi: 10.1177/1049732319866818..
Keywords: Surgery, Patient Safety, Adverse Events, Clinician-Patient Communication, Communication
White AEC
When and how do surgeons initiate noticings of additional concerns?
Physicians are trained on how to best solicit additional concerns from patients. What has not yet been studied is when and how physicians initiate additional concerns. This analysis focuses on when and how general surgeons share their noticings of medical problems unrelated to the upcoming (or recent) procedures that patients are being seen for.
AHRQ-funded; HS022236.
Citation: White AEC .
When and how do surgeons initiate noticings of additional concerns?
When and how do surgeons initiate noticings of additional concerns?.
Keywords: Clinician-Patient Communication, Surgery, Provider: Physician, Communication
Johnston FM, Beckman M
Navigating difficult conversations.
In this paper, the authors discussed breaking bad news and navigating difficult conversations in surgical oncology practice. They note that mounting evidence supports a patient-centered communication approach and models of shared decisionmaking. Physician training in patient-centered cancer communication also continues to evolve.
AHRQ-funded; HS024736.
Citation: Johnston FM, Beckman M .
Navigating difficult conversations.
J Surg Oncol 2019 Jul;120(1):23-29. doi: 10.1002/jso.25472..
Keywords: Cancer, Clinician-Patient Communication, Communication, Shared Decision Making, Patient-Centered Healthcare, Patient and Family Engagement, Provider: Physician, Surgery
Abelson JS, Chait A, Shen MJ
Coping strategies among colorectal cancer patients undergoing surgery and the role of the surgeon in mitigating distress: a qualitative study.
This study researched the role that surgeons can play in managing stress in patients undergoing colorectal cancer surgery. Patients were interviewed in-depth using open-ended questions. While patients did not believe surgeons are responsible for helping them cope, they do believe that they can play a role in managing their distress.
AHRQ-funded; HS000066.
Citation: Abelson JS, Chait A, Shen MJ .
Coping strategies among colorectal cancer patients undergoing surgery and the role of the surgeon in mitigating distress: a qualitative study.
Surgery 2019 Feb;165(2):461-68. doi: 10.1016/j.surg.2018.06.005..
Keywords: Cancer: Colorectal Cancer, Clinician-Patient Communication, Provider: Physician, Stress, Surgery
Rosenberg SM, Greaney ML, Patenaude AF
"I don't want to take chances.": a qualitative exploration of surgical decision making in young breast cancer survivors.
The purpose of this study was to better understand the choice of contralateral prophylactic mastectomy (CPM) through a qualitative exploration of surgical decision-making in young breast cancer survivors, including how issues particular to younger women affected their decision and the post-surgical experience. Through focus groups, themes emerged and were categorized. The authors concluded that informational resources and decision aids may enhance patient-doctor communication and help young survivors better understand risk and manage expectations surrounding short- and longer-term physical and emotional effects after surgery.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Greaney ML, Patenaude AF .
"I don't want to take chances.": a qualitative exploration of surgical decision making in young breast cancer survivors.
Psychooncology 2018 Jun;27(6):1524-29. doi: 10.1002/pon.4683.
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Keywords: Cancer: Breast Cancer, Shared Decision Making, Education: Patient and Caregiver, Clinician-Patient Communication, Surgery
Nabozny MJ, Kruser JM, Steffens NM
Patient-reported limitations to surgical buy-in: a qualitative study of patients facing high-risk surgery.
The researchers characterized how patients buy-in to treatments beyond the operating room and what limits they would place on additional life-supporting treatments. Their recordings of patients' pre- and post-operative conversations with surgeons showed that patients expressed trust in their surgeon to make decisions about additional treatments if a serious complication occurred. However, patients expressed a preference for significant treatment limitations that were not discussed with their surgeon preoperatively.
AHRQ-funded; HS000078.
Citation: Nabozny MJ, Kruser JM, Steffens NM .
Patient-reported limitations to surgical buy-in: a qualitative study of patients facing high-risk surgery.
Ann Surg 2017 Jan;265(1):97-102. doi: 10.1097/sla.0000000000001645.
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Keywords: Surgery, Palliative Care, Risk, Clinician-Patient Communication, Patient Safety
Boss EF, Mehta N, Nagarajan N
Shared decision making and choice for elective surgical care: a systematic review.
The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of shared decision making (SDM) in elective surgery. It concluded that SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.
AHRQ-funded; HS022932.
Citation: Boss EF, Mehta N, Nagarajan N .
Shared decision making and choice for elective surgical care: a systematic review.
Otolaryngol Head Neck Surg 2016 Mar;154(3):405-20. doi: 10.1177/0194599815620558.
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Keywords: Shared Decision Making, Surgery, Clinician-Patient Communication