Palliative care interventions for surgical patients: a narrative review

Kopecky, Kimberly E.; Florissi, Isabella; Greer, Jonathan B.; Johnston, Fabian M.

doi:10.21037/apm-22-770

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…The feasibility of preoperative ACP communication before high-risk cardiac surgeries has also been demonstrated in the USA [12]. However, no research has investigated the translation of this preoperative ACP communication into real practice, including decisional conflict, anxiety, satisfaction with decisionmaking in the index surgery, or regret regarding the decision to undergo the surgery among patients and their families [21,22]. Therefore, further studies are needed.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Nurse-Led Advance Care Planning Before Pre-cardiac Procedures: A Descriptive Study

Shigetomi,

Hiraoka,

Takahashi

et al. 2023

Cureus

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BackgroundShared decision-making is important for deciding whether to perform surgery, especially high-risk surgery, or end-of-life care in cases of serious complications after the surgery. In shared decision-making, surgeons should be aware of patients' values. Therefore, advance care planning (ACP) before the surgery is important. In Japan, the feasibility of ACP, particularly preoperative nurse-led ACP, is yet to be evaluated. MethodologyThis retrospective, single-center, descriptive study included all adult candidates for open-heart or thoracic aortic surgery and transcutaneous aortic valve implantation (TAVI) referred by their surgeon for a nurse-led preoperative ACP between April 1, 2020 and December 31, 2021. The nurse conducted semi-structured interviews with patients regarding goals of care, unacceptable conditions, undesired procedures, advance directives, and their surrogates and documented them. The content of these interviews and their influence on decision-making were retrospectively investigated. ResultsSixty-four patients (median age, 82 years; Society of Thoracic Surgeons (STS) score, 7.9; EuroSCORE II, 4.2; JapanSCORE, 7.0) were included (open-heart or thoracic aortic surgery 24, TAVI 40). Among them, 63 (98.4%), 56 (87.5%), and 13 (20.3%) patients articulated their goals of care, unacceptable conditions, and undesired procedures. Only one (1.6%) had a written advance directive. Although all of the patients could designated their surrogate, only 11 (17.2%) had shared their values disclosed in the pre-procedure ACP communication with their surrogates. Two patients who planned to undergo open-heart surgery disclosed their wish not to undergo the surgery only to the nurses but could not tell their surgeon; thereafter, the surgery was canceled. Three patients died after the procedure; however, the patients' value disclosed in ACP was not used for the end-of-life decision. ConclusionNurse-led ACP can be implemented before high-risk cardiac procedures. It may have an impact on the decision-making of surgery although the ACP content may not be utilized for the end-of-life discussion after the procedures between surgeons and the family member.

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Section: Discussionmentioning

confidence: 99%

Feasibility of Nurse-Led Advance Care Planning Before Pre-cardiac Procedures: A Descriptive Study

Shigetomi,

Hiraoka,

Takahashi

et al. 2023

Cureus

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“…El uso de un lenguaje natural para la comunicación de un diagnóstico severo, opciones terapéuticas, pronóstico, necesidad de acompañamiento paliativo, objetivos de cuidado y directrices avanzadas, permite un mejor procesamiento de la información y toma de decisiones consciente. 7 A pesar de que se ha reconocido que la comunicación es una parte esencial del entrenamiento médico desde las aulas hasta las áreas clínicas, el abordaje de "malas noticias", pronóstico y final de vida, siguen presentando un reto importante para los profesionales de la salud, tanto por las barreras personales como las presentes en su entorno clínico, por lo cual, será difícil encontrar una forma única para mejorar la comunicación. 8 En general, las habilidades de comunicación implican: contacto visual, uso de un lenguaje corporal apropiado, como una postura abierta, sentarse cerca del paciente, realizar una escucha activa, como asentir con la cabeza o hacer ruidos de afirmación o estímulo para indicar comprensión, reflejar empatía y mostrar compasión usando una actitud cálida, afectuosa y respetuosa.…”

Section: Comunicación Y Toma De Decisionesunclassified

El ABC de los cuidados paliativos para el cirujano general

Ortega Espino,

Serrano Pérez

2023

Cirujano General

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Existe una amplia gama de enfermedades que requieren atención de cuidados paliativos, tales como enfermedades neoplásicas, cerebrovasculares, del sistema nervioso central, entre otras enfermedades crónico-degenerativas. Con un enfoque en proveer alivio de los síntomas, dolor y estrés de una enfermedad severa, independientemente del diagnóstico o pronóstico, el objetivo de los cuidados paliativos es mejorar la calidad de vida tanto de los pacientes como de su familia o cuidadores primarios. El manejo básico de síntomas, la discusión del pronóstico, el abordaje de objetivos de tratamiento y decisiones al final de la vida, son elementos básicos de los cuidados paliativos que cualquier médico debería conocer, así como el momento en que debe realizar una consulta al equipo de cuidados paliativos.

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“…Although uncertainty itself poses no novelty, in recent years there has been increasing awareness of how clinicians manage uncertainty alongside evolving illnesses and developing therapeutics. Kopecky et al examine the current state of palliative care interventions among surgical patients (1). The authors present an updated review of the literature and elegantly summarize recent contributions to surgical palliative care using three foundational domains for future study highlighted in the seminal work by Lilley et al in 2018: (I) measuring outcomes that matter to patients, (II) communication and decision-making, and (III) delivery of palliative care to surgical patients (2).…”

Section: Introductionmentioning

confidence: 99%