Cunningham Holly B, Scielzo Shannon A, Nakonezny Paul A, Bruns Brandon R, Brasel Karen J, Inaba Kenji, Brakenridge Scott C, Kerby Jeffrey D, Joseph Bellal A, Mohler M J, Cuschieri Joseph, Paulk Mary E, Ekeh Akpofure P, Madni Tarik D, Taveras Luis R, Imran Jonathan B, Wolf Steven E, Phelan Herb A
1 Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
2 Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA.
Am J Hosp Palliat Care. 2019 Aug;36(8):669-674. doi: 10.1177/1049909118823182. Epub 2019 Jan 6.
The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties' attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty's ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so.
A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine.
Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions.
Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.
对于姑息治疗领域而言，为老年患者确定照护目标（GoC）的价值已广为人知，但对许多创伤外科医生来说却是一个较新的概念。对姑息治疗专家和创伤外科医生进行了调查，以了解这两个专业对以下方面的态度：（1）GoC对话对受伤老年人的重要性；（2）对自身专业进行这些对话能力的信心；（3）对另一专业进行此类对话能力的信心。
一个以姑息治疗为重点的多中心联盟的指导委员会制定了一份包含13个项目的调查问卷，并由与该联盟无关的创伤外科医生和姑息治疗专家进行了预测试。最终问卷通过电子方式分发给美国创伤外科学会和美国临终关怀与姑息医学学会的在职医生会员。
受访者包括118名创伤外科医生（8.8%）和244名姑息治疗专家（5.7%）。与创伤外科医生相比，姑息治疗医生认为自己对GoC更熟悉，更有可能报告在进行对话方面接受过高质量培训，认为重症监护病房需要更多姑息治疗专家，并且对进行对话更感兴趣。两组都认为自己在进行GoC讨论方面比对方专业所认为的做得更好，并且更倾向于由自己的专业主导团队讨论。
两组都认为自己在为受伤老年人进行GoC讨论方面比对方专业所认为的做得更好，这导致了对这些讨论的最佳主导者存在不同看法。
