Shabet Christina, Vitous C Ann, Evans Emily, Edwards Sydney, Bradley Sarah E, Duby Ashley, Suwanabol Pasithorn A
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
BMJ Support Palliat Care. 2025 Feb 26;15(2):270-280. doi: 10.1136/spcare-2024-004873.
End-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family members of veterans who died following surgery using the Veterans Affairs (VAs) Bereaved Family Survey (BFS).
We examined data from the BFS open-text responses to explore insights into surgical patient's end-of-life care. Data were analysed iteratively using qualitative content analysis and clustered into domains based on content.
We evaluated 936 open-text responses to the BFS for all decedents who underwent any high-risk surgical procedure across 124 VA medical centres from 2010 to 2019. This report focused on the following domains: patient needs, family/caregiver needs, clinical teams/personnel characteristics and facility/organisational characteristics. Key themes within patient needs included concerns about pain management, preservation of patient dignity and spiritual support. Within the family/caregiver domain, key themes included enhanced communication needs, assistance with logistics and displays of gratitude for the patient's military service. The clinical team's domain included the key themes of professionalism concerns and understaffing. Finally, key themes identified within the facility/organisation domain were the need for more robust support services and discomfort with the physical space.
Narratives from the family perspective provide valuable insight into end-of-life care among surgical patients. Our data demonstrate the critical need for preserving patient dignity and improved communication, which emphasises family involvement and shared decision-making. In addition, hospital systems can optimise nurse-to-patient ratios and intentionally design physical spaces to help improve end-of-life care for surgical patients.
外科患者的临终关怀在很大程度上未得到充分研究，从家庭角度审视此类关怀的研究要少得多。为了确定潜在的改进机会，我们使用退伍军人事务部（VA）丧亲家庭调查（BFS），探讨了术后死亡退伍军人家庭成员的反应。
我们检查了BFS开放式文本回复中的数据，以探究对外科患者临终关怀的见解。使用定性内容分析法对数据进行迭代分析，并根据内容聚类到不同领域。
我们评估了2010年至2019年期间，124个VA医疗中心所有接受任何高风险外科手术的死者对BFS的936条开放式文本回复。本报告重点关注以下领域：患者需求、家庭/护理人员需求、临床团队/人员特征以及机构/组织特征。患者需求中的关键主题包括对疼痛管理、维护患者尊严和精神支持的关注。在家庭/护理人员领域，关键主题包括增强沟通需求、后勤协助以及对患者军事服务的感激之情。临床团队领域包括专业精神问题和人员不足等关键主题。最后，在机构/组织领域确定的关键主题是需要更强大的支持服务以及对物理空间的不适。
从家庭角度的叙述为外科患者的临终关怀提供了宝贵的见解。我们的数据表明，维护患者尊严和改善沟通至关重要，这强调了家庭参与和共同决策。此外，医院系统可以优化护士与患者的比例，并有意设计物理空间，以帮助改善外科患者的临终关怀。
