Optimizing the End-of-Life Care Needs of Older Adults Undergoing Surgery

摘要 到2030年，65岁以上的成年人将超过美国人口的20%。与此同时， 在人口统计学上，这一人群的手术率预计将增加多达30%。此类患者 在术后发病率和死亡率中所占比例不成比例地高。虽然数量可观， 尽管人们已经努力减少术后并发症和死亡，但对 接受手术或考虑手术的老年人的临终护理（即，手术患者）。高 老年手术患者的高质量临终护理很少被患者告知， 家庭视角。此外，这种护理的要素定义不清，而且在很大程度上研究不足。通过 我们独特而强大的外科项目协作基础设施，密歇根州外科质量 协作（MSQC），我们将评估对临终关怀的满意度和质量， 使用先前验证的丧亲家庭调查和跨医院验证的质量措施进行手术 在密歇根州（目标1），并制定一个深入了解的关键要素，为改善结束， 为术后死亡风险高或预后差的老年人提供终身护理（目标2）。了解调查结果 在目标1和目标2中，我们将制定和试点测试一种干预措施， 手术患者及其家属（目标3）。MSQC是最大的基于人群的手术质量 在美国的改善协作，包括73家医院，每年代表超过50，000名患者。 这项研究将通过揭示外科医生如何 医院可以更好地预测和管理老年手术患者及其家属的临终关怀， 生活护理需要。这项研究的结果将为未来的研究提供必要的初步数据， 改善有术后死亡风险或预后不良的老年人临终护理的干预措施。 此外，这项研究计划将通过MSQC建立一个独特的数据基础设施， 未来的研究。该项目，多学科导师团队和教育计划非常适合 满足候选人Pasithorn A的职业和领导需求。Suwanabol，MD，MS. Suwanabol博士是 委员会认证的一般和结直肠外科与临床和研究的兴趣，姑息和临终关怀 老年外科病人的护理。她以前的研究经验，了解手术和 姑息治疗，以及外科医生在提供姑息治疗中的作用，已经为她做好了准备 提议然而，为了实现她的目标，成为改善老年人护理的领导者， 手术后死亡或预后不良的风险，她需要接受额外的培训， 通过先进的调查和定性方法进行研究，临床接触姑息治疗， 老年医学和领导力发展。

ABSTRACT By 2030, adults older than 65 years will exceed 20% of the U.S. population. In parallel to this rapidly changing demographic, rates of surgery in this population are expected to increase by as much as 30%. Such patients account for a disproportionately higher share of postsurgical morbidity and mortality. Although substantial efforts have been made to reduce postsurgical complications and death, far less attention has been aimed at end-of-life care in older adults undergoing surgery or being considered for surgery (i.e., surgical patients). High quality end-of-life care among older adult surgical patients is seldom informed by the patient and family perspective. Further, elements of this care are poorly defined and largely understudied. Through our unique and robust collaborative infrastructure of surgical programs, the Michigan Surgical Quality Collaborative (MSQC), we will evaluate perceived satisfaction with and quality of end-of-life care following surgery using a previously validated Bereaved Family Survey and validated quality measures across hospitals in Michigan (Aim 1), and develop an in-depth understanding of the key elements necessary for improved end- of-life care for older adults at high risk of postsurgical death or poor outcomes (Aim 2). Informed from findings in Aims 1 and 2, we will then develop and pilot test an intervention aimed at improving end-of-life care for surgical patients and their families (Aim 3). The MSQC is the largest population-based surgical quality improvement collaborative in the U.S. comprising 73 hospitals and representing over 50,000 patients per year. This study will have an immediate impact on local and national initiatives by revealing how surgeons and hospitals can better anticipate and manage older adult surgical patients and their families’ end-of- life care needs. Results from this study will provide essential preliminary data for future studies aimed at interventions that improve end-of-life care for older adults at risk of postsurgical death or poor outcomes. Further, this research plan will lead to a unique data infrastructure through the MSQC that can be used for future studies. The project, the multidisciplinary mentorship team, and educational plan are ideally suited to address the career and leadership needs of the candidate, Pasithorn A. Suwanabol, MD, MS. Dr. Suwanabol is board-certified in general and colorectal surgery with a clinical and research interest in palliative and end-of-life care for older adult surgical patients. Her prior research experience understanding variation in surgical and palliative care, as well as the surgeon’s role in the provision of palliative care, has prepared her for this proposal. However, in order to achieve her goal of becoming a leader in improving care for older adults at high risk of postsurgical death or poor outcomes, she requires additional training in engaging patients and families into research through advanced survey and qualitative methods, clinical exposure to palliative care and geriatrics, and leadership development.