Defining Serious Illness Among Adult Surgical Patients.

Autor: Lee KC; The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Surgery, University of California, San Diego, La Jolla, California, USA. Electronic address: kclee@bwh.harvard.edu., Walling AM; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA; Greater Los Angeles Veterans Affairs Healthcare System, David Geffen School of Medicine at University of California, Los Angeles, California, USA; Affiliated Adjunct Staff, RAND Health, Los Angeles, California, USA., Senglaub SS; The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA., Kelley AS; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Cooper Z; The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Hebrew SeniorLife Marcus Institute for Aging Research, Boston, Massachusetts, USA; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2019 Nov; Vol. 58 (5), pp. 844-850.e2. Date of Electronic Publication: 2019 Aug 09.
DOI: 10.1016/j.jpainsymman.2019.08.003
Abstrakt: Context: Palliative care (PC) for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased health care utilization. However, efforts to integrate PC alongside restorative surgical care are limited by the lack of a consensus definition for serious illness in the perioperative context.
Objectives: The objectives of this study were to develop a serious illness definition for surgical patients and identify a denominator for quality measurement efforts.
Methods: We developed a preliminary definition including a set of criteria for 11 conditions and health states. Using the RAND-UCLA Appropriateness Method, a 12-member expert advisory panel rated the criteria for each condition and health state twice, once after an in-person moderated discussion, for validity (primary outcome) and feasibility of measurement.
Results: All panelists completed both rounds of rating. All 11 conditions and health states defining serious illness for surgical patients were rated as valid. During the in-person discussion, panelists refined and narrowed criteria for two conditions (vulnerable elder, heart failure). The final definition included the following 11 conditions and health states: vulnerable elder, heart failure, advanced cancer, oxygen-dependent pulmonary disease, cirrhosis, end-stage renal disease, dementia, critical trauma, frailty, nursing home residency, and American Society of Anesthesiology Risk Score IV-V.
Conclusion: We identified a consensus definition for serious illness in surgery. Opportunities remain in measuring the prevalence, identifying health trajectories, and developing screening criteria to integrate PC with restorative surgical care.
(Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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