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Older adult perspectives on medical decision making and emergency general surgery: : "it had to be done"
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CONTEXT: Optimal surgical care for older adults with life-threatening conditions, with high risk of poor perioperative outcomes and morality in the months after surgery, should incorporate an understanding of the patient's treatment goals and preferences. However, little research has explored the patient perspective of decision making and advanced care planning during an emergency surgery episode.
OBJECTIVE: We sought to better understand older patients' lived experience making decisions to undergo emergency general surgery (EGS) and perceptions of perioperative advance care planning.
METHODS: Adults >65 who underwent one of seven common EGS procedures with a length of stay >5 days at 3 Boston-area hospitals were included. Semi-structured phone interviews were conducted 3 months post-discharge. Transcripts were reviewed and coded independently by surgeons and palliative care physicians to identify themes.
RESULTS: Thirty-one patients were interviewed. Patients viewed the decision for surgery as a choice of life over death and valued prolonging life. They felt there was "no choice" but to proceed with surgery, but reported that participation in decision making was limited due to severe symptoms, time constraints and confused thinking. Despite recently surviving a life-threatening illness, patients had not reconsidered their wishes for the future and preferred to avoid future advance care planning.
CONCLUSION: Older patients who survived a life-threatening illness and emergency general surgery report receiving goal-concordant care in the moment that relieved symptoms and prolonged life but had not considered future care. Interventions to facilitate postoperative advance care planning should be targeted to this vulnerable group of older adults.
http://dx.doi.org/10.1016/j.jpainsymman.2020.09.039
Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»
Autres numéros de la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»
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