How the “Worst Case Scenario” Benefits Patients

THE GOOD NEWS IS the authors of this study developed a communication framework that improves shared decision-making for patients facing high-stakes surgical procedures. The bad news is… it still requires breaking the bad news.

In order to better engage patients in their treatment decisions, surgeons in the study were trained to use the “Best Case/Worst Case” communication framework.

By describing the best, worst, and most likely scenarios their patient could experience from proposed treatment alternatives, surgeons were able to acknowledge the patient’s personal preferences while helping them reach a decision for their unique situation.

“After training, surgeons using Best Case/Worst Case clearly presented a choice between treatments, described a range of postoperative trajectories including functional decline, and involved patients and families in deliberation,” says the author of the study.

Best Case/Worst Case also has the potential to work with patients who have preference sensitive conditions, which CMS defines as “one for which there are multiple treatment options and no clear evidence on which approach is best.”

While we wish for the best in every scenario, sometimes there is no room for sugarcoating. And for patients risking the worst case outcome, compassionate honesty is the best call.

Take care.