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Palliative Care in the Surgical Intensive Care Unit

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Surgical Critical Care Therapy

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Abstract

Patients with critical illness or injury deserve excellent symptom management, psychosocial support, and expert guidance in decision-making. Palliative care addresses the needs of patients and families at all stages of serious illness, including at the end of life or alongside life-prolonging treatments. All physicians should be comfortable providing primary palliative care to critically ill patients and engaging in shared decision-making. Surgeons can use structured communication tools to conduct patient-centered goals of care discussions and to facilitate provision of treatment recommendations that align with patient values. Specialized palliative care teams can support surgical teams in delivering high-quality care by addressing potentially unfamiliar issues such as existential suffering, spiritual unrest, and challenging family dynamics. Surgeons have a responsibility to prioritize patient autonomy within the context of serious illness and to ensure avoidance of unwanted burdensome treatments at the end of life.

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References

  1. Ernst KF, Hall DE, Schmid KK, et al. Surgical palliative care consultations over time in relationship to systemwide frailty screening. JAMA Surg. 2014;149:1121–6.

    Article  Google Scholar 

  2. Miner TJ, Cohen J, Charpentier K, McPhillips J, Marvell L, Cioffi WG. The palliative triangle: improved patient selection and outcomes associated with palliative operations. Arch Surg. 2011;146:517–22.

    Article  Google Scholar 

  3. Lilley EJ, Khan KT, Johnston FM, et al. Palliative care interventions for surgical patients: a systematic review. JAMA Surg. 2016;151:172–83.

    Article  Google Scholar 

  4. American College of Surgeons and Task Force on Surgical Palliative Care and Committee on Ethics. Statement of principles of palliative care. Bull Am Coll Surg. 2005;90(8):34–35.

    Google Scholar 

  5. Kross EK, Engelberg RA, Downey L, et al. Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians. Chest. 2014;145:313–21.

    Article  Google Scholar 

  6. Olmsted CL, Johnson AM, Kaboli P, Cullen J, Vaughan-Sarrazin MS. Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration. JAMA Surg. 2014;149:1169–75.

    Article  Google Scholar 

  7. Kwok AC, Semel ME, Lipsitz SR, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378:1408–13.

    Article  Google Scholar 

  8. World Health Organization. Cancer Pin Relief. Geneva: WHO; 1986.

    Google Scholar 

  9. Hearn J, Higginson IJ. Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group. Qual Health Care. 1999;8:219–27.

    Article  CAS  Google Scholar 

  10. Hall DE, Arya S, Schmid KK, et al. Development and initial validation of the risk analysis index for measuring frailty in surgical populations. JAMA Surg. 2017;152:175–82.

    Article  Google Scholar 

  11. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210:901–8.

    Article  Google Scholar 

  12. Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013;206:544–50.

    Article  Google Scholar 

  13. Hall DE, Arya S, Schmid KK, et al. Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg. 2017;152:233–40.

    Article  Google Scholar 

  14. Rodriguez-Manas L, Feart C, Mann G, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2013;68:62–7.

    Article  Google Scholar 

  15. Kon AA, Davidson JE, Morrison W, Danis M, White DB. Shared Decision-Making in Intensive Care Units. Executive Summary of the American College of Critical Care Medicine and American Thoracic Society Policy Statement. Am J Respir Crit Care Med. 2016;193:1334–6.

    Article  Google Scholar 

  16. Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217:833–42. e1–3

    Article  Google Scholar 

  17. Kon AA, Davidson JE, Morrison W, Danis M, White DB. Shared Decision Making in ICUs: an American College of Critical Care Medicine and American Thoracic Society Policy Statement. Crit Care Med. 2016;44:188–201.

    Article  Google Scholar 

  18. Schwarze ML, Bradley CT, Brasel KJ. Surgical “buy-in”: the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy. Crit Care Med. 2010;38:843–8.

    Article  Google Scholar 

  19. Nabozny MJ, Kruser JM, Steffens NM, et al. Patient-reported limitations to surgical buy-in: a qualitative study of patients facing high-risk surgery. Ann Surg. 2017;265:97–102.

    Article  Google Scholar 

  20. Cooper Z, Koritsanszky LA, Cauley CE, et al. Recommendations for best communication practices to facilitate goal-concordant care for seriously ill older patients with emergency surgical conditions. Ann Surg. 2016;263:1–6.

    Article  Google Scholar 

  21. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346:1061–6.

    Article  Google Scholar 

  22. Quill TE, Holloway R. Time-limited trials near the end of life. JAMA. 2011;306:1483–4.

    Article  CAS  Google Scholar 

  23. Schwarze ML, Kehler JM, Campbell TC. Navigating high risk procedures with more than just a street map. J Palliat Med. 2013;16:1169–71.

    Article  Google Scholar 

  24. Kruser JM, Taylor LJ, Campbell TC, et al. “Best case/worst case”: training surgeons to use a novel communication tool for high-risk acute surgical problems. J Pain Symptom Manag. 2017;53:711–9. e5

    Article  Google Scholar 

  25. Blinderman CD, Billings JA. Comfort care for patients dying in the hospital. N Engl J Med. 2015;373:2549–61.

    Article  CAS  Google Scholar 

  26. The American Board of Surgery. Diplomat totals. 2017. http://www.absurgery.org/default.jsp?statsummary. Accessed 13 Apr 2017.

  27. Lupu D. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manag. 2010;40:899–911.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Washington, Seattle, WA, USA

    Kathleen O’Connell

  2. Department of Trauma, Burn, and Surgical Critical Care, Brigham and Women’s Hospital, Boston, MA, USA

    Zara Cooper

Authors
  1. Kathleen O’Connell
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  2. Zara Cooper
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Corresponding author

Correspondence to Zara Cooper .

Editor information

Editors and Affiliations

  1. Brigham and Womens’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Ali Salim

  2. Dell Medical School, University of Texas at Austin, Austin, Texas, USA

    Carlos Brown

  3. Division of Trauma Surgery, Rm C5L100, University of Southern California, Los Angeles, California, USA

    Kenji Inaba

  4. Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, Oregon, USA

    Matthew J. Martin

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O’Connell, K., Cooper, Z. (2018). Palliative Care in the Surgical Intensive Care Unit. In: Salim, A., Brown, C., Inaba, K., Martin, M. (eds) Surgical Critical Care Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_58

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  • DOI: https://doi.org/10.1007/978-3-319-71712-8_58

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71711-1

  • Online ISBN: 978-3-319-71712-8

  • eBook Packages: MedicineMedicine (R0)

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