Please select the eligibility criteria that correspond to the clinical trial below.
Title: Navigating High Risk Surgery: Empowering Older Adults to Ask Questions That Inform Decisions About Surgical Treatment
Brief Summary: The investigators will perform a multi-site cluster randomized trial that uses a stepped-wedged design to compare the effectiveness of a Question Prompt List (QPL) intervention to usual care for patients considering high-risk vascular (peripheral, cardiac, neuro) and oncologic operations. This 24-month study will use a time-dependent cluster randomization plan within each of the five study sites: the investigators will randomly assign time points for surgeons who perform high risk operations to cross over from usual care to QPL intervention. Study staff will audiotape the conversation between the patient and surgeon during one preoperative clinic visit; administer surveys to patients and family members at 24 hours, 6 weeks and 12 weeks after that visit; and record surgical decisions, treatments received and associated outcomes. The investigators will use stratified purposeful sampling to identify a subset of patients in each study arm who have experienced serious complications for qualitative interviews.


Options:
A: Inclusion Criteria:

* child in household in designated study area of Nepal, age 1 month to 12 years
* family agrees to enrollment

Exclusion Criteria:

* parent refuse to enroll child
B: Patient Eligibility Criteria

Inclusion Criteria:

* Patients over 18 years old, diagnosed with ischemic stroke (including transient ischemic attack) with symptoms lasting up to 24 hours.

Exclusion Criteria:

* Patients with signs of hemorrhagic stroke, expansive lesions, central nervous system infections, and those coming from institutions that did not provide institutional approval form signed by the patients' guardians.

Cluster Eligibility Criteria

Inclusion Criteria:

* Hospitals with a emergency department, with available tomography, neurologist and alteplase

Exclusion Criteria:

* Hospitals that don't provide Institutional Authorization Form
C: Inclusion Criteria:

CHWs in districts with ICCM implementation

Exclusion Criteria:

CHWs in districts without ICCM implementation
D: Surgeons

Inclusion Criteria:

* Consenting surgeons at participating hospital sites who practice vascular, cardiothoracic, hepatobiliary, colorectal, urologic, gynecologic, head and neck or neurosurgery
* Regularly see patients preoperatively in the surgical clinic
* Perform high risk operations on older patients with multiple comorbid conditions

Exclusion Criteria:

* Exclusively perform minimally invasive surgery (laparoscopy), endocrine or breast surgery as these procedures are not typically considered "high risk"
* Patient panel is not generally comprised of older adults considering high risk procedures

Patients

Inclusion Criteria:

* Age 60 and older
* One or more chronic conditions from a list comprised of those included in the Charlson Comorbidity Index with 9 additional conditions included due to their saliency to surgical decision making
* Have an upcoming outpatient consultation with an enrolled surgeon to discuss treatment for a vascular or oncologic problem that can be treated with a high risk operation
* English speaking and Spanish-speaking patients who require an interpreter will be included

Exclusion Criteria:

* Lack decision-making capacity
* Deemed too physically or mentally ill to participate by their surgeon or clinic nurse
* Self-report that their vision or literacy skills are too poor to read a newspaper
* Cannot speak either English or Spanish with the fluency required to have a valid medical decision-making conversation as the QPL is currently only available in English and Spanish (Spanish speaking patients who require an interpreter to speak with their surgeon will be included)
* Participating surgeons may also choose to exclude specific patients for study participation based on their own concerns about the patient participating in the study, for example patients who have urgent surgical needs or don't actually have a surgical problem

Family members

Inclusion Criteria:

* Family member (patient participant) is enrolled in the study
* Present at time of patient enrollment in study

Exclusion Criteria:

* Lack decision-making capacity
* Self-report that their vision or literacy skills are too poor to read a newspaper
* Cannot speak either English or Spanish with the fluency required to have a valid medical decision-making conversation as the QPL is currently only available in English and Spanish (Spanish speaking patients who require an interpreter to speak with the surgeon will be included)

Answer: D