Palliative Care Consultation Is Underutilized in Critically Ill General Surgery Patients

Abstract

Background: American College of Surgeons recommends palliative care and surgeons collaborate on the care of patients with poor prognoses. These collaborations are done to discuss symptom management and goals of care. However, contemporary practice patterns of palliative care consultation for surgical patients are poorly defined. We aim to describe the use of palliative care consultation for patients admitted to our institution’s surgical services who died during their index hospital admission. Methods: The Duke Enterprise Data Unified Content Explorer 2014 to 2016 was queried for patients admitted to general surgery services who died during their admission. Secondary measures included length of stay, time spent in consultation, days from consultation to death, and execution of a care plan. Results: Of the 105 patients identified, 6 died on the day of admission, and 39 (37%) received palliative care consultation. Our data showed that patients who received consultation were generally older, white, and insured. Median number of days between palliative consult and death was 3 days (interquartile range: 1-8). Goals-of-care conversations were the indication for consultation in 62.5% of patients. The proposed plan by the consultants was congruent with the primary team in 66.7% of cases. Conclusions: Palliative care consultations were underutilized in surgical patients who died while admitted to the general surgical service at our institution. When palliative care is consulted, the plan of the primary surgical team and the palliative team align. Identification of barriers to consultation and promotion of the benefits of palliative care among surgical teams is warranted.

Were Clinical Routines for Good End-of-Life Care Maintained in Hospitals and Nursing Homes During the First Three Months of the Outbreak of COVID-19? A National Register Study

“…Given that less than 3% of all patients in this study had a specialised palliative care team involved, one might wonder whether more involvement from specialised palliative care teams would have increased the overall care quality. To compare, in a study by Evans et al, 37% of critically ill general surgery patients received a palliative care consultation and this was considered underutilisation (29).…”

“…Given that less than 3% of all patients in this study had a specialised palliative care team involved, one might wonder whether more involvement from specialised palliative care teams would have increased the overall care quality. To compare, in a study by Evans et al, 37% of critically ill general surgery patients received a palliative care consultation and this was considered underutilisation ( 29 ). The availability to, and organisation of, specialised palliative care varies in Sweden ( 4 ), and the pre-pandemic referral of nursing home residents to specialised palliative care was uncommon.…”

Implementation of a Surgical Intensivist Model Increases Palliative Care Consultation in the Care of Trauma ICU Patients

“…14 There is evidence that, in the past, palliative care consultation was underutilized in the care of critically ill general surgery patients. 15 In the geriatric trauma population, palliative care remains underutilized among patients dying within 6 months after discharge. 16 Early goals of care discussions and multidisciplinary family meetings are associated with increased comfort care measures for imminently dying trauma patients.…”

Primary palliative care for surgeons: a narrative review and synthesis of core competencies

“…They found that patients admitted with gastrointestinal or thoracic malignancies undergoing surgery were 79% less likely to receive PC consultation than patients who did not undergo surgery during their inpatient admission (36). Likewise, Evans and coauthors found that PC consultation was requested in only 37% of cases where critically ill general surgery patients died during hospital admission (37). Aslakson et al reviewed 37 publications that addressed the evidence base of thirty PC interventions in the ICU.…”