Specialist Palliative Care in Surgical Oncology

外科肿瘤学的早期专科姑息护理 摘要 对于老年患者来说，临终关怀(EOL)通常是零散的、昂贵的、不必要的 咄咄逼人，不足以提供舒适和尊严。专家姑息治疗咨询是一种策略 改善EOL护理。姑息治疗提供者的参与也被证明改善了临床和 在危及生命的疾病的治疗过程中早期启动时，患者报告的结果， 尤其是癌症。然而，早期姑息护理在老年人中的效用没有得到很好的研究。 癌症的外科手术。有一种尚未得到满足的驱动需求，以改善接受手术的患者的预后 同时改善对那些最终死于疾病的人的EOL护理。早期姑息治疗 协商是满足这一需求的一种很有前途的战略。 选择姑息治疗专家(SCOPE)的癌症手术试验将开始回答 接受癌症手术的患者是否会从早期姑息治疗中受益的问题。 SCOPE是一项随机对照试验，招募了236名接受恶性肿瘤切除术的患者 尤其是糟糕的预测。在介入臂中，患者接受手术前会诊 姑息治疗提供者与持续的住院和门诊姑息治疗术后随访。 控制性手臂患者将得到常规护理。范围试验的具体目的是确定：1) 干预是否改善90天后的身体和功能生活质量；2)干预是否 患者的手术恢复、癌症存活率和临终关怀都有所改善；以及3) 干预患者对自己的护理和需求有不同的看法。 Scope试验是Myrick Shinall博士职业发展计划的一部分，以成熟为一名 对严重年龄外科患者姑息治疗干预的益处的独立研究人员- 相关条件。Scope试验将为Shinall博士提供一个平台，以启动更大、更密集的 老年外科人群中姑息治疗的调查。在进行试验的同时，希纳尔博士还将 接受流行病学、定性研究方法、老龄化研究和领导力方面的培训。他会的 此外，他还受益于他的主要导师E·韦斯利·伊利博士的指导，他坚持 独立的联邦资金已有15年，并指导了几名年轻的调查人员在 进程。教学培训、伊利博士的指导和从指导中获得的经验的结合 Scope试验将使Shinall博士发展成为姑息治疗干预的独立调查者 在有严重年龄相关疾病的外科患者中。

Early Specialist Palliative Care in Surgical Oncology Abstract For elderly patients, care at the end of life (EOL) is often fragmented, expensive, needlessly aggressive, and insufficient to provide comfort and dignity. Expert palliative care consultation is one strategy to improve EOL care. Involvement of palliative care providers has also been shown to improve clinical and patient-reported outcomes when initiated early in the course of treatment for life-threatening diseases, especially cancer. However, the utility of early palliative care is not well studied in older adults undergoing surgery for cancer. There is a driving unmet need to improve outcomes of patients undergoing surgery for cancer while improving EOL care for those who ultimately succumb to their disease. Early palliative care consultation is a promising strategy to meet this need. The Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial will begin to answer the question of whether patients undergoing surgery for cancer will benefit from early palliative care. SCOPE is a randomized controlled trial enrolling 236 patients undergoing resections for malignancies with particularly poor prognoses. In the intervention arm, patients receive a pre-operative consultation with a palliative care provider along with continued inpatient and outpatient palliative care follow-up post-operatively. Control arm patients will receive usual care. The Specific Aims of the SCOPE Trial are to determine: 1) whether the intervention improves physical and functional quality of life at 90 days; 2) whether intervention patients have improved recovery from surgery, cancer survivorship, and end of life care; and 3) whether the intervention patients perceive their care and needs differently. The SCOPE Trial forms part of the career development plan of Dr. Myrick Shinall to mature into an independent researcher of the benefit of palliative care interventions for surgical patients with serious age- related conditions. The SCOPE Trial will provide a platform for Dr. Shinall to launch larger, more intensive investigations of palliative care in older surgical populations. While conducting the trial, Dr. Shinall will also undertake training in epidemiology, qualitative research methods, aging research, and leadership. He will additionally benefit from the guidance of his primary mentor, Dr. E. Wesley Ely, who has maintained independent federal funding for 15 years and has mentored several young investigators to independence in the process. The combination of didactic training, Dr. Ely’s mentorship, and experience gained from conducting the SCOPE trial will allow Dr. Shinall to develop into an independent investigator of palliative care interventions in surgical patients with serious age-related conditions.