What Should the Surgeons Do at the Family Meeting: A Multi-Disciplinary Qualitative Description of Surgeon Participation in Palliative Care Discussions

Schultz, Kristen; Howard, Shannon; Moreno, Kirstin; Siegel, Timothy; Zonies, David; Brasel, Karen J.; Cook, Mackenzie R.

doi:10.1016/j.jsurg.2022.08.008

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…Expanding the ability to project palliative care skills outside of large centers with the use of telemedicine and education will enhance opportunities for robust GOC conversations. 4,[15][16][17][18] Lastly, we know that trauma transfer patterns and policies vary regionally and that GOC practices reflect the culture of an institution. This is why we propose a multi-center study as a future step in this work.…”

Section: Discussionmentioning

confidence: 99%

“…It is not sufficient for an accepting physician just to say “no” without assuring that the nursing support, physician expertise, institutional resources, and patient desire are present to assure high quality end of life care at the referring hospital. Expanding the ability to project palliative care skills outside of large centers with the use of telemedicine and education will enhance opportunities for robust GOC conversations 4,15–18 . Lastly, we know that trauma transfer patterns and policies vary regionally and that GOC practices reflect the culture of an institution.…”

Section: Discussionmentioning

confidence: 99%

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Goals of care are rarely discussed prior to potentially futile trauma transfer: Is it okay to say “No”?

Trenga-Schein,

Zonies,

Cook

2023

J Trauma Acute Care Surg

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Background It is unknown how often the physician-to-physician trauma transfer conversation includes a discussion of patient goals of care (GOC). We hypothesized that physicians would rarely discuss GOC on transfer calls when faced with patients with catastrophic injuries. Methods We completed a retrospective case series of trauma patients transferred to an ACS verified level 1 trauma center between 2018 and 2022 who died or were discharged to hospice without surgical intervention within 48 hours. Transfer call recordings were analyzed for GOC conversations. Results A total of 5,562 patients were accepted as transfers and 82 (1.5%) met inclusion criteria. Eighty of the 82 patients had recorded transfer calls and were analyzed. The most common transfer reason was traumatic brain injury (TBI) and need for neurosurgical capabilities (53%) followed by complex multisystem trauma (23%). There was explicit discussion of code status prior to transfer in 20% and a more in depth GOC conversation for 10% patients. Appropriateness of transfer was discussed in 21% and at least one physician expressed explicit concerns of futility for 14%, though all were subsequently transferred. Code status was changed immediately upon arrival for 15% for patients and 19% of patients transferred neurosurgical expertise were deemed to have non-survivable injuries based on the imaging and exam that was unchanged from the referring hospital. Conclusions Among a group of profoundly injured trauma patients at high risk of death, an explicit discussion of GOC occurred in just 10%. This suggests that even when the catastrophic nature of patient injury is understood, transfers still occur, and patients and their families are subjected to an expensive, disruptive, and displacing experience with little to no anticipated benefit. A discussion of GOC and therapeutic objectives should be considered in all severely injured trauma patients prior to transfer. Level of Evidence IV (Observational Retrospective Case Series)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Goals of care are rarely discussed prior to potentially futile trauma transfer: Is it okay to say “No”?

Trenga-Schein,

Zonies,

Cook

2023

J Trauma Acute Care Surg

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“…Caregivers’ desire for end-of-life information also signifies emergency preparedness. Research reveals unmet treatment-related knowledge and needs among pediatric patients’ families [ 7 , 31 ]. Approximately 85% of communication time involves physicians providing disease and treatment information, neglecting the variation in patients’ knowledge preferences, attitudes, and needs across illness stages [ 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care: a cross-sectional investigation in pediatric settings in China

Lin,

Qulian,

Bai

et al. 2024

BMC Nurs

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Background Countries abroad have implemented pediatric palliative treatment for several years; however, complete pediatric palliative treatment guidelines and legal guidance remain lacking in China, making the implementation of palliative care difficult. Purpose This study aimed to understand the current situation, similarities, and differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care for children. Methods This cross-correlation study collected data from pediatric and neonatal intensive care units of four hospitals in China. The participants comprised 180 caregivers and 172 healthcare providers. The measurement tools included the palliative care knowledge scale, palliative care attitude scale, and pediatric palliative care needs scale. This study adhered to the STROBE reporting guidelines. Results Significant differences in palliative care knowledge, attitudes, and needs were observed between caregivers and healthcare providers (p < 0.005). Pediatric healthcare providers demonstrated higher knowledge and positive attitudes regarding palliative care than caregivers. Needs for communication in general and relief from pain and other symptoms of caregivers were higher than those of healthcare providers (p < 0.001). Furthermore, palliative care attitude and needs of healthcare providers were positively correlated with each other (r = 0.212, p < 0.005). Conclusion Pediatric healthcare providers and caregivers demonstrated different perceptions of needs for palliative care. The results of this study can serve as a reference for the future development of guidelines related to children’s needs and related interventions.

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Roles of pediatric surgeons in palliative pediatric oncology

Le,

Braungart,

Shalkow‐Klincovstein

et al. 2024

Pediatric Blood & Cancer

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Pediatric surgeons engaged in oncology will inevitably treat patients receiving palliative care, but their role in this context is poorly described. This article identifies some of the challenges and opportunities of surgical involvement in pediatric oncology palliative care, underscoring how the surgeon's expertise can be exploited to significantly benefit children with cancer. Specific examples of skills (procedural, communication, and coordination) that surgeons can provide to the multidisciplinary palliative care teams are described and the importance of collaboration is highlighted.

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What Should the Surgeons Do at the Family Meeting: A Multi-Disciplinary Qualitative Description of Surgeon Participation in Palliative Care Discussions

Cited by 5 publications

References 24 publications

Goals of care are rarely discussed prior to potentially futile trauma transfer: Is it okay to say “No”?

Goals of care are rarely discussed prior to potentially futile trauma transfer: Is it okay to say “No”?

Differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care: a cross-sectional investigation in pediatric settings in China

Roles of pediatric surgeons in palliative pediatric oncology

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