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A framework to help clinicians discuss high-stakes decisions with patients and their families.

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A framework to help clinicians discuss dialysis treatment options with frail older patients and their families

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A framework to help clinicians discuss the trajectory of critical illness with patients, their families, and other care team members.

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The Patient Preferences Project, led by vascular surgeon and medical ethicist Margaret “Gretchen” Schwarze, MD, MPP, helps older patients who are considering major surgery make decisions that are in line with their values, goals and preferences.

Why? Although surgery can improve symptoms and prolong life, for many older patients — especially those with multiple chronic health problems — it can also result in serious complications, a loss of independence or a significant decrease in quality of life. For those patients, the decision to have surgery can start a course of care that may lead to prolonged life support, long-term care in a nursing home, or other potentially unwanted outcomes.

The Patient Preferences Project team develops tools to help patients and surgeons communicate more clearly before surgery, so that patients can better understand what their lives might look like after surgery — and make the choice that’s right for them.

Patients don’t need more information, they need more interpretation

Ann J. Russ and Sharon R. Kaufman,
Family Perceptions of Prognosis, Silence, and the “Suddeness” of Death

Featured videos


Best Case/Worst Case

Our research group developed a communication tool called Best Case/Worst Case (BC/WC) intended for face-to-face discussions about treatment options in the context of serious illness. BC/WC is an intervention to support decision making that builds on the conceptual model of shared decision making and uses scenarios to help patients and families imagine what life might look like if they had surgery. BC/WC combines narrative description and a hand written graphic aid to illustrate a choice between treatments and to engage patients and families in deliberation. For each treatment, the surgeon describes a range of possible outcomes in the best case, worst case, and most likely scenarios.

Best Case/Worst Case: Nephrology

Best Case/Worst Case Nephrology uses the original Best Case/Worst Case framework to help clinicians discuss and plan for dialysis treatment options with patients who have chronic kidney disease.

Best Case/Worst Case: ICU

Best Case/Worst Case: ICU helps critical care clinicians discuss uncertainty and the trajectory of illness and injury with patients, their families, and other care providers.   




Wisconsin Surgical Outcomes Research Program
Department of Surgery
University of Wisconsin School of Medicine and Public Health



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