Question Coding Schema: A Toolkit to Count and Categorize Questions During Surgical Consultation

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There is increasing interest in Shared Decision Making (SDM) as a way to empower patients to meaningfully participate in the treatment decision making process alongside physicians. Patient activation is seen as a key component of SDM and includes encouraging patients to ask more questions of their care providers. Although questions play an important role in communication between clinicians, patients and family members, there is little published guidance on measuring question asking by patients and family members. We developed this codebook to fill that gap, building upon prior work (Walczak et al., 2014). The resultant coding schema is a measurement tool for characterizing the number and types of questions patients and family members ask during surgical consultations.

This coding schema enables researchers to count and describe the categories of questions that patients and family members ask while meeting with their surgeon. The coding schema may be used with data that is naturalistic, such as audio-recordings of consultations. We do not advise using it with reactive data, such as focus groups, interviews or surveys. As it was developed for use in a study of surgeon-patient communication it will require adaptation for use in other clinical contexts.

Who should use this toolkit?

This toolkit is intended for researchers interested in patient-physician communication, patient activation, and related areas of study.

Researchers can also use the coding schema to measure question asking as an indicator of patient activation, either for descriptive purposes or to evaluate the impact of an intervention intended to increase activation.

What does the toolkit contain?

This toolkit contains a PDF codebook that you can download and use in your research. The codebook includes instruction on what to count as a question, how to handle interpreted and translated content, and detailed coding rules for topic area.

Note: This toolkit will be updated in the future to include a template coding sheet and other materials.

How should these tools be used?

The materials in this toolkit can be used to:

  1. Determine the number and characterize type of questions asked by patients and family members during surgical consultations
  2. Characterize the impact of an intervention designed to increase or change question asking by patients and family members

Development of this toolkit

The Question Coding Schema toolkit was developed by researchers and clinicians (Principal Investigator: Margaret Schwarze) at the Wisconsin Surgical Outcomes Research Program within the University of Wisconsin-Madison School of Medicine & Public Health – Department of Surgery.

This project was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (CDR1502-27462). Additional support was provided by the University of Wisconsin School of Medicine and Public Health’s Health Innovation Program (HIP), the Wisconsin Partnership Program, and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 9 U54 TR000021 from the National Center for Advancing Translational Sciences (previously grant 1 UL1 RR025011 from the National Center for Research Resources). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders.

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The coding schema builds upon prior methodological work available in the following article:

Walczak A, Butow PN, Clayton JM, Tattersall MH, Davidson PM, Young J, Epstein RM. Discussing prognosis and end-of-life care in the final year of life: a randomised controlled trial of a nurse-led communication support programme for patients and caregivers. BMJ Open. 2014 Jun 26;4(6):e005745.

Toolkit Citation

We suggest using the following citation for this toolkit: Buffington AS and Schwarze ML, Patient Preferences Project, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health. Madison, WI; 2019. Available at


About the Authors

Margaret “Gretchen” Schwarze, MD, MPP, FACS is an Associate Professor with the University of Wisconsin – Madison Department of Surgery, Division Vascular of Surgery. Her research focuses on improving communication between older patients and their surgeons, so that patients can avoid unwanted treatment and make decisions that align with their values, preferences and goals. She is an alumna of the Greenwall Faculty Scholars program and currently holds a GEMSSTAR (R03 NIA)/Jahnigen Award from the American Geriatrics Society and the Society for Vascular Surgery to test a communication intervention for older, frail surgical patients, a grant from the National Palliative Care Research Center to adapt this tool for older patients with end-stage renal disease, and an award from the Patient-Centered Outcomes Research Institute to test a Surgical Question Prompt List intervention in a randomized controlled trial.