Surgery
Conditions
Keywords
Surgery, Goals, Communication guide
Brief summary
The Facilitating Goal-based Conversations for Understanding Surgery (FOCUS) Guide is a communication intervention designed to support discussion and documentation of the goal for surgery during outpatient surgical consultations. The purpose of this study is to assess the efficacy of the FOCUS guide in prompting discussion of the goal for surgery.
Detailed description
More than 300,000 older adults undergo major non-urgent surgery annually in the United States. Older adults often prioritize independence, quality of life, and preservation of function over life prolongation when making treatment decisions. However, surgical consultations rarely include explicit discussion or documentation of the goal for surgery. Existing surgical communication often focuses on disease-centered or "fix-it" models of care, emphasizing surgical correction of structural disease rather than discussion of outcomes that matter most to patients. As a result, patients may develop unrealistic expectations regarding surgical outcomes and may experience postoperative distress when outcomes do not align with expectations. The Facilitating Goal-based Conversations for Understanding Surgery (FOCUS) Guide is a communication intervention designed to support discussion and documentation of the goal for surgery during outpatient surgical consultations. By facilitating explicit discussion of the goal for surgery, the intervention seeks to align surgical care with patient priorities and improve patient-centered care.
Interventions
OTHERFOCUS Guide
The FOCUS Guide is a communication intervention designed to support discussion and documentation of the goal for surgery during outpatient surgical consultations.
Sponsors
University of Utah
National Institute on Aging (NIA)
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Intervention model description
The study includes: * Pre-intervention (usual care) cohort * Surgeon training period * Post-intervention (FOCUS Guide) cohort Patients in the pre-intervention group will undergo surgical consultations according to usual care. Patients in the intervention group will undergo surgical consultations using the FOCUS Guide. All patients will undergo assessments immediately following the consultation and again at 3 months.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
For surgeons 1\. Surgeons who have regular outpatient clinics at the University of Utah and Huntsman Cancer Institute For patients: 1. Age ≥65 years. 2. Presenting for in-person outpatient consultation regarding major non-urgent surgery with an enrolled surgeon. 3. Ability to provide informed consent. 4. English-speaking.
Exclusion criteria
For surgeons 1. Surgeons with a predominantly pediatric practice 2. Transplant surgeons For patients 1. Anticipated life expectancy \<3 months. 2. Inability to complete study procedures. 3. Patients presenting for minor procedures or non-operative consultations. 4. Telehealth consultation 5. Any clinical, cognitive, communication, or logistical factor that, in the opinion of the treating surgeon or investigator, would substantially interfere with participation or completion of study procedures.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Goal Discussion | During the surgical consultation | Presence or absence of explicit discussion of the goal for surgery during the surgical consultation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Goal Documentation | Immediately following the surgical consultation through 3 months | Presence or absence of documentation of the goal for surgery in the surgical consultation note. |
| Goal-Concordant Care | Immediately following the surgical consultation through 3 months | Goal-concordant care will be assessed immediately following the surgical consultation using the Modified Health Outcome Prioritization Tool and associated alignment item |
Contacts
CONTACTSierra McNall, BS
CONTACTJordan Johnson, MPH
PRINCIPAL_INVESTIGATORJessica Cohan, MD
University of Utah
Outcome results
None listed