Clinical Challenges in Surgical Palliative Care: “When the horse is out of the barn: Skills to avoid offering surgical overtreatment at the end of life"

Sep 25, 2023

Dr. Katie O’Connell, surgeon specialized in surgical palliative care, discusses the challenges of offering surgery as the right treatment. Learn about recognizing when surgery is not beneficial, communicating serious news to patients, integrating palliative care into surgical practices, limitations of surgery in end-of-life situations, communicating with patients about surgery and alternative treatment options, describing comfort-focused treatments, and the challenges of surgical palliative care.

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Introduction

00:00 • 2min

Integrating Palliative Care into Surgical Practices

01:31 • 9min

Limitations of Surgery in End-of-Life Situations and Importance of Emotional Responses

10:37 • 2min

Communicating with a Patient about Surgery and Alternative Treatment Options

12:45 • 2min

Describing Comfort Focused Treatments to Patients and Families

14:35 • 2min

Challenges and Communication in Surgical Palliative Care

16:08 • 6min

Surgeons are trained to, well…do surgery, but is that always the right treatment for the patient? Not offering surgery can be a challenge, especially when you’re consulted about a sick patient in the middle of the night and the clinical momentum is moving toward the OR. Join Drs. Katie O’Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington as we discuss how to recognize when a surgery is potentially not beneficial and communicate serious news with the patient and consulting team.

Hosts:
Dr. Katie O’Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.

Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow.

Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology fellow at the University of Washington.

Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington.

Learning Objectives:

Identify when a patient’s disease course is unlikely reversible by surgery

Learn to avoid defaulting to offering potentially non-beneficial surgical treatment for patients at the end-of-life

Learn to recommend comfort-focused treatments for patients at the end-of-life

Develop the communication skill of delivering serious news

References:

1. Cooper Z, Courtwright A, Karlage A, Gawande A, Block S. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg. Dec 2014;260(6):949-57. doi:10.1097/SLA.0000000000000721

2. VitalTalk. One page Guides. https://www.vitaltalk.org/guides/

3. VitalTalk. Using Ask-Tell-Ask to Make a Recommendation.

https://www.vitaltalk.org/using-ask-tell-ask-to-make-a-recommendation/

4. VitalTalk. What's a Headline? https://www.vitaltalk.org/whats-a-headline/

5. Zaza SI, Zimmermann CJ, Taylor LJ, Kalbfell EL, Stalter L, Brasel K, Arnold RM, Cooper Z, Schwarze ML. Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons. Ann Surg. 2023 Mar 1;277(3):405-411. doi: 10.1097/SLA.0000000000005765. Epub 2022 Nov 24. PMID: 36538626; PMCID: PMC9905263.

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If you liked this episode, check out other surgical palliative care episodes here: https://behindtheknife.org/podcast-category/palliative-care/