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.

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.

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.