Berlin Ana, Kunac Anastasia, Mosenthal Anne C
Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Ann Palliat Med. 2017 Apr;6(2):178-182. doi: 10.21037/apm.2016.11.07. Epub 2016 Nov 29.
Patients with postoperative complications are often subjected to prolonged life-sustaining treatment based on erroneous assumptions about their goals of care. Shared decision making (SDM) is an evidence-based approach that helps ensure patients' wishes and values are honored in their course of treatment. Perioperative palliative care can help create goal-concordant trajectories of care for high risk, seriously ill, or complicated patients, through sophisticated prognostication, higher-level communication, and recommendations based on the best available evidence and patients' stated goals and priorities. Here, we present a surgeon-to-surgeon consultative model that surmounts many barriers to perioperative palliative care consultation and, as illustrated in the cases presented herein, offers profound and unique benefits for patients, families, and surgeons alike. While the support of a surgical colleague with palliative care skills can be helpful postoperatively in the setting of unanticipated outcomes or prolonged recovery, it is particularly beneficial when accessed preoperatively for the purposes of goal-concordant decision making and advance care planning. We encourage both individuals and professional societies to develop and expand the niche for surgeons interested in assisting with goal setting and SDM for patients on a consultative basis, particularly in the preoperative period.
术后并发症患者常常基于对其治疗目标的错误假设而接受延长生命的治疗。共同决策（SDM）是一种基于证据的方法，有助于确保在患者的治疗过程中尊重其意愿和价值观。围手术期姑息治疗可以通过复杂的预后评估、更高层次的沟通以及基于最佳现有证据、患者明确的目标和优先事项的建议，帮助为高风险、重症或复杂患者创建与目标一致的治疗轨迹。在此，我们提出一种外科医生之间的咨询模式，该模式克服了围手术期姑息治疗咨询的许多障碍，并且如本文所呈现的案例所示，为患者、家属和外科医生都带来了深远而独特的益处。虽然具备姑息治疗技能的外科同事的支持在术后出现意外结果或恢复时间延长的情况下可能会有所帮助，但在术前为了进行与目标一致的决策和预先护理计划而获得这种支持则尤其有益。我们鼓励个人和专业协会为有兴趣在咨询基础上协助患者进行目标设定和共同决策的外科医生发展并扩大这一领域，特别是在术前阶段。
