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%。与这一快速变化并行的是 从人口统计来看，这一人群的手术率预计将增加30%。这样的病人 占手术后发病率和死亡率的比例高得不成比例。虽然数量很大 在减少手术后并发症和死亡率方面已经做出了努力，但针对以下方面的关注要少得多 正在接受手术或正在考虑接受手术的老年人(即手术患者)的临终关怀。高 老年外科患者的高质量临终关怀很少被患者和 家庭视角。此外，这种护理的要素定义不明确，而且在很大程度上缺乏研究。穿过 我们独特而强大的外科项目协作基础设施，密歇根外科质量 协作(MSQC)，我们将评估对以下临终关怀的感知满意度和质量 使用先前经过验证的丧亲家庭调查和医院间经过验证的质量指标进行手术 在密歇根州(目标1)，并深入了解改善最终目标所需的关键要素 为手术后死亡或预后不佳的老年人提供生命护理(目标2)。从调查结果中获知 在目标1和目标2中，我们将开发和试行旨在改善临终关怀的干预措施 外科病人及其家属(目标3)。MSQC是最大的基于人群的外科质量 在美国由73家医院组成的协作式改进，每年代表50,000多名患者。 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人的临终关怀 生活护理需求。这项研究的结果将为未来旨在 改善对有手术后死亡或预后不良风险的老年人的临终关怀的干预措施。 此外，这项研究计划将通过MSQC产生一个独特的数据基础设施，可用于 未来的研究。该项目、多学科指导团队和教育计划非常适合 解决候选人Pasithorn A.Suwanabol，MD的职业和领导需求，Suwanabol博士 获得普通外科和结直肠外科委员会认证，对姑息性和临终关怀有临床和研究兴趣 护理老年外科病人。她以前的研究经验理解了外科手术和 姑息治疗，以及外科医生在提供姑息治疗方面的作用，使她为此做好了准备 求婚。然而，为了实现她成为改善老年人护理的领导者的目标， 手术后死亡或预后不良的风险，她需要额外的培训，让病人和家人参与进来 通过高级调查和定性方法进行研究，临床接受姑息治疗和 老年病学和领导力发展。

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.