1 University of Michigan Medical School, Ann Arbor, Michigan.
2 Department of Surgery, University of Michigan, Ann Arbor, Michigan.
J Palliat Med. 2019 Feb;22(2):132-137. doi: 10.1089/jpm.2018.0197. Epub 2018 Nov 17.
Surgical patients most commonly receive palliative care services within 24-48 hours of death, and reasons for this delay are poorly understood. Research with nonsurgeons suggests that physician characteristics and beliefs about death and dying may contribute to late referral.
To describe surgeon perspectives related to death and dying, and their relationship with delayed referrals to palliative care.
Using a previously validated survey instrument supplemented by open-ended questions, deductive content analysis was used to describe surgeon preferences for end-of-life care.
Participants were all current nonretired members of the American Society of Colon and Rectal Surgeons.
Surgeon descriptions of a "good death" and how personal experiences influence care provided.
Among 131 survey respondents (response rate 16.5%), 117 (89.3%) completed all or part of the qualitative portion of the survey. Respondents consistently reported their personal preferences for end-of-life care, and four central themes emerged: (1) pain and symptom management, (2) clear decision making, (3) avoidance of medical care, and (4) completion. Surgeons also reflected on both good and bad experiences with patients and family members dying, and how these experiences impact practice.
The small sample size inherent to Internet surveys may limit generalizability and contribute to selection bias.
This study reveals surgeon preferences for end-of-life care, which may inform initiatives aimed at surgeons who may underuse or delay palliative care services. Future studies are needed to better understand how surgeon preferences may directly impact treatment recommendations for their patients.
外科患者通常在死亡前 24-48 小时内接受姑息治疗服务，而导致这种延迟的原因尚未得到很好的理解。非外科医生的研究表明，医生的特点和对死亡的信念可能会导致延迟转介。
描述外科医生对死亡和临终的看法，以及这些看法与向姑息治疗延迟转介的关系。
使用先前验证过的调查工具，并辅以开放式问题，采用演绎内容分析法来描述外科医生对终末期护理的偏好。
参与者均为美国结肠直肠外科学会的现任非退休成员。
外科医生对“善终”的描述以及个人经历如何影响所提供的护理。
在 131 名调查对象中（应答率为 16.5%），有 117 名（89.3%）完成了调查中定性部分的全部或部分内容。应答者一致报告了他们对终末期护理的个人偏好，出现了四个中心主题：（1）疼痛和症状管理，（2）明确决策，（3）避免医疗护理，以及（4）完成。外科医生还反思了他们在患者和家属死亡方面的好坏经历，以及这些经历如何影响他们的实践。
互联网调查固有的小样本量可能会限制其普遍性，并导致选择偏差。
本研究揭示了外科医生对终末期护理的偏好，这可能为旨在可能过度使用或延迟姑息治疗服务的外科医生的举措提供信息。需要进一步的研究来更好地了解外科医生的偏好如何直接影响他们对患者的治疗建议。
