Palliative care in a rural surgery residency program: an educational needs assessment.

Background: There is a deficiency of palliative care education in surgical residency programs and a lack of research on palliative care education in rural surgery residency programs. Because rural palliative care presents unique challenges due to fewer specialists and resources, we investigated potential areas of improvement in palliative care education in a rural general surgery residency program.

Methods: An anonymous survey was sent to all residents of a rural general surgery residency program.

Top Ten Tips Palliative Care Clinicians Should Know About Leveraging the Electronic Health Record for Data Collection and Quality Improvement.

As palliative care (PC) programs rapidly grow and expand across settings, the need to measure, improve, and standardize high-quality PC has also grown. The electronic health record (EHR) is a key component of these efforts as a central hub of care delivery and a repository of patient and system data. Deliberate efforts to leverage the EHR for PC quality improvement (QI) can help PC programs and health systems improve care for patients with serious illnesses.

Annual Structured Communication Skills Training for Surgery Residents.

Introduction: There is no formalized communication curriculum for surgical training. The aim of this study is to determine the benefit of annual communication skill-building workshops for surgical residents over several years.

Methods: The general surgery and the integrated cardiothoracic surgery residents in a tertiary care, urban academic center participated in a 2-hour communication skill-building workshop each year from July 2017 to June 2021.

Reduction of Unnecessary Gastrostomy Tube Placement in Hospitalized Patients.

Background: Many patients undergoing gastrostomy tube placement at one academic medical center were able to resume an oral diet prior to discharge or did not survive hospitalization. The objective of this study was to reduce placement of nonbeneficial gastrostomy tubes and to maintain or improve adherence to gastrostomy tube guidelines.

Methods: In February 2017 the Acute Care Surgery service began an initiative in which gastrostomy tube placement was deferred until the patient was deemed medically stable for discharge.

Virtual Interinstitutional Palliative Care Consultation during the COVID-19 Pandemic in New York City.

Amid the COVID-19 surge in New York City, the need for palliative care was highlighted. Virtual consultation was introduced to expand specialist-level care to meet demand. To examine the outcomes of COVID-19 patients who received virtual palliative care consultation from outside institutions.

Close Encounters of the First Kind: An Interdisciplinary Ethics of Care Approach Mitigates Moral Injury and Family Division in the Midst of Covid-19.

In this compelling personal narrative describing a case from the front lines of the COVID-19 pandemic, a palliative care physician harnesses the creative powers and strengths of the interdisciplinary team to provide compassionate care to a critically ill patient and his family. The author describes the process of identifying a surrogate decision maker from among the patient's many adult children-several of whom were estranged from him and each other-and facilitating weighty decisions about his end-of-life care. Over the course of this journey, the author grapples with her inner biases and struggles with the emotional trauma associated with bearing witness to extraordinary suffering and social isolation imposed by COVID-19.

Sarcopenia is Predictive of Functional Outcomes in Older Trauma Patients.

Introduction:  Older patients are more vulnerable to poor outcomes after trauma than younger patients. Sarcopenia, loss of skeletal mass, is prevalent in trauma patients admitted to the intensive care unit (ICU), and it has been shown to correlate with adverse outcomes, such as mortality and ICU days. Yet, little is known whether it predicts other outcomes.

Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery: A Multisite Randomized Clinical Trial.

Importance: Poor preoperative communication can have serious consequences, including unwanted treatment and postoperative conflict.

Objective: To compare the effectiveness of a question prompt list (QPL) intervention vs usual care on patient engagement and well-being among older patients considering major surgery.

Design, Setting, And Participants: This randomized clinical trial used a stepped-wedge design to randomly assign patients to a QPL intervention (n = 223) or usual care (n = 223) based on the timing of their visit with 1 of 40 surgeons at 5 US study sites.

Older Patients With Severe Traumatic Brain Injury: National Variability in Palliative Care.

Background: Older patients with traumatic brain injury (TBI) have higher mortality and morbidity than their younger counterparts. Palliative care (PC) is recommended for all patients with a serious or life-limiting illness. However, its adoption for trauma patients has been variable across the nation.

Emergency abdominal surgery in patients presenting from skilled nursing facilities: Opportunities for palliative care.

Background: Residents of skilled nursing facilities (SNF) with acute abdomen present with more comorbidities and frailty than community-dwelling (CD) counterparts. Outcomes in this population are poorly described.

Methods: We hypothesized that SNF patients have higher mortality and morbidity than CD patients.

Concurrent Palliative Care for Surgical Patients.

A common fallacy prevalent in surgical culture is for surgical intervention and palliation to be regarded as mutually exclusive or sequential strategies in the trajectory of surgical illness. Modern surgeons play a complex role as both providers and gatekeepers in meeting the palliative needs of their patients. Surgical palliative care is ideally delivered by surgical teams as a component of routine surgical care, and includes management of physical and psychosocial symptoms, basic communication about prognosis and treatment options, and identification of patient goals and values.

Communication Skills Training for General Surgery Residents.

Background: Although good communication skills are essential for surgeons, there is no formal communication training during general surgery residency.

Objectives: To implement a communication skills training program based on evidence-based teaching methods in general surgery residency.

Design: We developed a 2-hour communication skills training program for general surgery residents, consisting of a small group skill practice session using role play with simulated patients along with real-time feedback from facilitators and observing peer residents.

Patients with End-Stage Renal Disease and Acute Surgical Abdomen: Opportunities for Palliative Care.

End-stage renal disease (ESRD) is a life-limiting condition that is often complicated by acute abdominal emergency. Palliative care (PC) has been shown to improve the quality of life in patients with serious illness and yet is underutilized. We hypothesize that ESRD patients with abdominal emergency have high unmet PC needs.

Establishing Goals of Care for Patients With Stroke and Feeding Problems: An Interdisciplinary Trigger-Based Continuous Quality Improvement Project.

Background: Few patients with dysphagia because of stroke receive early palliative care (PC) to align treatment goals with their values, as called for by practice guidelines, particularly before enteral access procedures for artificial nutrition.

Measures: To increase documented goals of care (GOC) discussions among acute stroke patients before feeding gastrostomy tube placement.

Intervention: We undertook a rapid-cycle continuous quality improvement process with interdisciplinary planning, implementation, and performance review to operationalize an upstream trigger for PC referral prompted by the speech and language pathology evaluation.

Outcomes and palliative care utilization in patients with dementia and acute abdominal emergency: opportunities for surgical quality improvement.

Background: When patients with dementia develop acute surgical abdomen, patients, surrogates, and surgeons need accurate prognostic information to facilitate goal-concordant decision making. Palliative care can assist with communication, symptom management, and family and caregiver support in this population. We aimed to characterize outcomes and patterns of palliative care utilization among patients with dementia, presenting with abdominal surgical emergency.

Goals of Care and End of Life in the ICU.

Despite advances in surgical critical care, critical illness remains traumatic and has long-term adverse sequelae. Unrealistic expectations and erroneous assumptions about outcomes acceptable to patients have been identified as drivers of goal-discordant treatment. Goal setting in the ICU begins with compassionately delivered, accurate, and honest prognostic information.