Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients
Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients
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DOI：
10.1177/1049909118823182
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发表时间：
2019-08-01
影响因子：
1.9
通讯作者：
Phelan, Herb A.
中科院分区：
文献类型：
--
作者：
Cunningham, Holly B.;Scielzo, Shannon A.;Phelan, Herb A.
背景资料：为老年患者定义护理目标（GoC）的价值是姑息治疗社区所熟知的，但对许多创伤外科医生来说是一个较新的概念。对姑息治疗专家和创伤外科医生进行了调查，以了解专科医生对以下方面的态度：（1）GoC对话对受伤老年人的重要性;（2）对自己专科进行这些对话的能力的信心;（3）对其他专科进行这些对话的能力的信心。研究方法：一项13项调查是由一个多中心的、以姑息治疗为重点的联盟的指导委员会制定的，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β测试。最终确定的文书以电子方式分发给美国创伤外科协会和美国临终关怀和姑息医学学会的在职医生成员。结果：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%）。姑息治疗医生更熟悉GoC，更有可能报告进行对话的高质量培训，认为重症监护室需要更多的姑息治疗专家，并且相对于创伤外科医生对进行对话更感兴趣。两组人都认为自己比其他专业更能进行GoC讨论，并倾向于自己的专业领导团队讨论。结论：这两个群体都认为自己比其他专业更好地为受伤的老年人进行GoC讨论，这导致了对这些讨论的最佳领导的不同看法。
Background: 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. Methods: 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. Results: 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. Conclusions: 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.