Advantages and Challenges of an Interdisciplinary Palliative Care Team Approach to Surgical Care

Rhee, Charles; McHugh, Marlene; Tun, Sandy; Gerhart, James; O’Mahony, Sean

doi:10.1016/j.suc.2019.05.004

Cited by 16 publications

(14 citation statements)

References 25 publications

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“…As we more clearly define the value of PC services, including how value relates to the timing of those consults, we can begin to work toward universal acceptance and standardization of concordant expert PC in comprehensive trauma care. The provision of expert PC services concurrent with disease-directed therapies is known to effectively alleviate patient suffering and avert goal- and value-incongruent care, as well as improve quality of life 8,10,15–17 . Our hypothesis was that injured patients receiving an early PC consultation would realize lower health care utilization and fewer aggressive interventions.…”

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confidence: 99%

“…This recommendation was largely based on work that showed earlier placement of do-not-resuscitate orders and withdrawal of life-sustaining medical treatments (LSMTs) through the integration of a structured interdisciplinary PC model in a closed surgical and trauma ICU 2 . Despite the poignancy of these findings and the clear economic and clinical benefit of early specialty PC consultation for noninjured patients, which has been established within the healthcare industry at large, 3–6 significant barriers to the integration of PC specifically for injured patients as a whole remain 7–9 …”

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confidence: 99%

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Timing is everything: Early versus late palliative care consults in trauma

Spencer

Russell

Cornea

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:The incorporation of dedicated palliative care (PC) services in the care of the critically injured trauma patient is not yet universal. Preexisting data demonstrate both economic and clinical value of PC consults, yet patient selection and optimal timing of these consults are poorly defined, possibly leading to underutilization of PC services. Prior studies in geriatric patients have shown benefits of PC when PC clinicians are engaged earlier during hospitalization. We aim to compare hospitalization metrics of early versus late PC consultation in trauma patients. METHODS:All patients 18 years or older admitted to the trauma service between January 1, 2019, and March 31, 2021, who received a PC consult were included. Patients were assigned to EARLY (PC consult ≤3 days after admission) and LATE (PC consult >3 days after admission) cohorts. Demographics, injury and underlying disease characteristics, outcomes, and financial data were compared. Length of stay (LOS) in the EARLY group is compared with LOS-3 in the LATE group. RESULTS:A total of 154 patient records met the inclusion criteria (60 EARLYand 94 LATE). Injury Severity Score, head Abbreviated Injury Scale score, and medical comorbidities (congestive heart failure, dementia, previous stroke, chronic obstructive pulmonary disease, malignancy) were similar between the groups. The LATE group was younger (69.9 vs. 75.3, p = 0.04). Patients in the LATE group had significantly longer LOS (17.5 vs. 7.0 days, p < 0.01) and higher median hospital costs ($53,165 vs. $17,654, p < 0.01).Patients in the EARLY group had reduced ventilator days (2.4 vs. 7.0, p < 0.01) and reduced rates of tracheostomies and surgical feeding tubes (1.7% vs. 11.7%, p = 0.03). CONCLUSION:Trauma patients with early PC consultation had shorter LOS, reduced ventilator days, reduced rates of invasive procedures, and lower costs even after correcting for delay to consult in the late group. These findings suggest the need for mechanisms leading to earlier PC consult in critically injured patients.

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confidence: 99%

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confidence: 99%

Timing is everything: Early versus late palliative care consults in trauma

Spencer

Russell

Cornea

et al. 2022

J Trauma Acute Care Surg

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“…The low number of responses from surgical specialties could be described by limited training, lack of mentoring, and less willingness to utilize Palliative Care services are the main barriers to Palliative Care utilization amongst surgical specialties. 22,23 Recently published studies have proposed that the use of advanced perioperative Palliative Care can bene t patients undergoing high risk surgeries by providing better medical team-patient -family understanding of end-of-life care, communication, and support. It is important for surgical specialties to be educated about Palliative Care and how it is bene cial for their patients 24,25 .…”

Section: Discussionmentioning

confidence: 99%

Assessment and Comparison of Competencies, Attitudes and Knowledge of Palliative Care amongst Physicians, Advance Practice Providers, Residents, and Medical Students.

Kawai

Davis

Weber

2023

Preprint

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Background Palliative Care prevents and relieves burdensome symptoms and suffering in patients who have life-limiting or chronic illness. This is accomplished through the early identification and treatment of pain and other physical, psychosocial, or spiritual stressors. The creation of a new Palliative Care program at a county teaching hospital in late 2021 and the subsequent rapid expansion of its services generated the need for targeted education programs for medical staff. The first step was to determine Palliative Care competencies, attitudes, and knowledge among the medical personnel at the institution. Methods The purpose of this study was to collect and compare baseline self-assessed competencies, attitudes and knowledge of Palliative Care and its applications amongst Physicians/Advance Practice Providers (APPs), Residents/Fellows, and medical students. The email survey was distributed to 322 attending physicians/APPs, 301 resident/fellow physicians, and 447 medical students. 144 total responses were received, with 129 responses being complete, providing a total response rate of 13.5%. Results Overall knowledge score of Palliative Care was significantly lower in medical students (7.27 out of a possible maximum score of 12) when compared to attending physicians/APPs (9.64, p < 0.001) and resident/fellow physicians (9.38, p < 0.001). The vast majority of respondents acknowledged that Palliative Care would greatly benefit their own patient population or future patient populations [attending physicians/APPs 74.4%, resident/fellow physicians 94.9%, medical students 80.4%] and that their department/colleagues could benefit from Palliative Care education [attending physicians/APPs 74.4%, resident/fellow physicians 94.9%, medical students 88.2%]. Conclusion Study findings suggest that medical students have less knowledge and confidence utilizing Palliative Care than practicing physicians/APPs. This suggests that providing Palliative Care Medical Education early in the medical school curriculums could ultimately improve patient care. Similarly, practicing physicians/APPs and trainees at all levels could benefit from further education in Palliative Care.

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“…The primary goal of a palliative care (PC) clinician is to recommend treatment modalities that reduce suffering and help patients and their loved ones achieve their best QOL in the context of serious illness. Existing data suggests that the provision of PC concurrent with disease-directed therapy is beneficial for patients and their loved ones (4). Palliative care should be differentiated from hospice as care that is delivered to all patients with a life-limiting illness regardless of life expectancy.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical care, as currently practiced, often fails to satisfy the palliative needs of seriously ill or injured surgical patients (7), as surgeons often erroneously view surgical intervention and palliation as mutually exclusive (8). Gaps in whole person care have been identified and can be addressed by concurrent primary and/or specialty palliative care as each patient's needs dictate (4). In order for surgeons to integrate palliative care into their practice patterns, a greater understanding of the added benefit is required and additional training must be obtained.…”

Section: Introductionmentioning

confidence: 99%