Training Surgeons and Anesthesiologists to Facilitate End-of-Life Conversations With Patients and Families: A Systematic Review of Existing Educational Models

Bakke, Katherine; Miranda, Stephen P.; Castillo-Ángeles, Manuel; Cauley, Christy E.; Lilley, Elizabeth J.; Bernacki, Rachelle; Bader, Angela M.; Urman, Richard D.; Cooper, Zara

doi:10.1016/j.jsurg.2017.08.006

Cited by 32 publications

(19 citation statements)

References 43 publications

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“…This is compounded by a lack of quality research into educational programmes for surgical trainees in the literature. A 2018 systematic review of studies of educational models for surgeons focussing on end-of-life care and treatment escalation discussions found a low quantity and quality of research in this area [20]. Our evaluation showed how basic education can provide limited improvements.…”

Section: Discussionmentioning

confidence: 83%

Pre-operative resuscitation discussion with patients undergoing fractured neck of femur repair: a service evaluation and discussion of current standards

Heylen

Kemp

MacDonald

et al. 2021

Arch Orthop Trauma Surg

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Introduction The majority of neck of femur (NOF) fracture patients are frail and at a higher risk of cardiac arrest. This makes discussion of treatment escalation vital to informed care. The optimal time for these discussions is prior to admission or trauma. However, when this has not occurred, it is vital that these discussions happen early in the patient's admission when family is often present and before further deterioration in their condition. We undertook a service evaluation to evaluate and discuss the effect of clinician education on improving rates of timely discussion amongst orthopaedic doctors. Materials and methodsThe first cycle included 94 patients. Their notes were reviewed for presence of a ReSPECT (Recommend Summary Plan for Emergency Care and Treatment) form prior to operation and whether this it countersigned by a consultant. Following this, clinician education was undertaken and a re-audit was carried out involving 57 patients. Results ReSPECT form completion rates rose from 23% in cycle 1-32% in cycle 2 following intervention. The proportion which consultants signed rose from 41% to 56% following intervention. Conclusion This project demonstrates how a basic education program can prove limited improvements in the rates of timely resuscitation discussions. We discuss a current lack in quality research into educational programs for discussion of treatment escalation for orthopaedic trainees. We suggest there is room to improve national best practice guidelines and training to ensure these discussions are carried out more frequently and to a better standard.

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Section: Discussionmentioning

confidence: 83%

Pre-operative resuscitation discussion with patients undergoing fractured neck of femur repair: a service evaluation and discussion of current standards

Heylen

Kemp

MacDonald

et al. 2021

Arch Orthop Trauma Surg

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“…Curricular enhancement should include palliative care topics, including oral diagnosis and management in this context and communication strategies to facilitate a palliative care oral health plan . These principles are well‐developed in surgical medicine and nursing education, and inclusion in dentistry would enhance dental education and the education of collaborative care trainees and colleagues. Improved health professions education should also collectively include content on provider self‐care, including dual management of the cognitive and emotional load, stress response leading to either a good or bad outcome (compassion fatigue, burnout, or resilience), types of coping mechanisms (active vs avoidance), and finding balance.…”

Section: Discussionmentioning

confidence: 99%

Recurrent oral squamous cell carcinoma‐incorporating advance care planning in education and practice

Munz

Helman

Tiner

et al. 2019

Special Care in Dentistry

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This reflection describes a life‐limiting case of oral squamous cell carcinoma (SCC) that required thoughtful management facilitated by an advance care plan (ACP). A 70‐year‐old female was diagnosed with a T4aN2bM0 biopsy‐proven invasive, well‐differentiated keratinizing SCC. Surgical wide‐local excision included teeth #11‐16 with left unilateral neck dissection, levels I‐V. She was rehabilitated with maxillary obturator prosthesis and underwent chemoradiation therapy. Her course was complicated by dysphagia and trismus. She experienced multiple recurrences. At a certain point, negative margins could not be achieved without facial disfigurement. The patient, her husband, and providers decided together that further management would be palliative. Before the additional surgical procedures, she communicated a thorough ACP with her husband and providers who were prepared to facilitate difficult care decisions on her behalf. The patient passed away at home with hospice care at the age of 74. This motivated patient with oral SCC and impactful postmanagement complications appreciated the clarity of an ACP. Her values and goals of care were incorporated with ongoing communication and documentation of this plan, which was instrumental in facilitating her person‐centered care. The providers apply lessons learned here in future practice and education of residents and students.

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“…A cursory education about end of life care and high-stakes communication based on clinical exposure is no longer adequate, and there is very limited education in medical school on this topic [ 98 , 99 ]. As might be expected from the limited efficacy data, there are precious little data on the optimal approach to teaching residents and medical students key communication skills [ 100 , 101 ]. Resident self-reported comfort with providing end-of-life care does not correlate well with experience providing end-of-life care, although a formal curriculum may [ 102 ].…”

Section: Educating the Next Generationmentioning

confidence: 99%

Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient

2020

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Purpose of Review Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.

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Training Surgeons and Anesthesiologists to Facilitate End-of-Life Conversations With Patients and Families: A Systematic Review of Existing Educational Models

Cited by 32 publications

References 43 publications

Pre-operative resuscitation discussion with patients undergoing fractured neck of femur repair: a service evaluation and discussion of current standards

Pre-operative resuscitation discussion with patients undergoing fractured neck of femur repair: a service evaluation and discussion of current standards

Recurrent oral squamous cell carcinoma‐incorporating advance care planning in education and practice

Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient

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