Clinical Challenges in Surgical Palliative Care: Non-Beneficial Surgery (and How to Avoid it) and Care of the Imminently Dying Patient

Behind The Knife: The Surgery Podcast

Education, Science, Health & Fitness, Medicine

4.8 • 1.4K Ratings

🗓️ 26 December 2022

⏱️ 35 minutes

🔗️ Recording | iTunes | RSS

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Summary

Welcome to the fifth of a six-part series focused on the integration of palliative care into the practice of surgery. In this episode, we discuss nonbeneficial surgery (and how best to avoid it) as well as care of the imminently dying patient.

Nonbeneficial surgery is best defined as surgery that fails to meet the goals of the patient. As our surgical patients become older and more medically complex, we must be aware of the factors which lead to nonbeneficial surgery – including patient, surrogate, system, and surgeon factors – and how best to approach each of these to avoid causing harm to our patients. Nonbeneficial surgery not only causes harm to the patient, but can also cause harm to the surgical team, in the form of moral distress/injury. Focusing on patients’ goals of care can help us to avoid nonbeneficial surgery.

One of the benefits of integrating palliative medicine into the practice of surgery is that there is never “nothing left to do.” By learning how to recognize and then care for the imminently dying patient, as well as by having a basic understanding of the Medicare hospice benefit, we can support and care for the patient (and the family) beyond the operating room.

Non-Beneficial Surgery:

Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution.
https://pubmed.ncbi.nlm.nih.gov/24866541/

Surgeons’ perspectives on avoiding nonbeneficial treatments in seriously ill older patients with surgical emergencies: a qualitative study.
https://pubmed.ncbi.nlm.nih.gov/27105058/

The association between factors promoting beneficial surgery and moral distress: a national survey of surgeons.
https://pubmed.ncbi.nlm.nih.gov/33214444/

The Imminently Dying Patient and Hospice:

Fast Fact #3: Syndrome of Imminent Death
https://www.mypcnow.org/fast-fact/syndrome-of-imminent-death/

Fast Fact #82: Medicare Hospice Benefit – Part 1: Eligibility and Treatment
https://www.mypcnow.org/wp-content/uploads/2019/01/FF-82-Medicare-Hospice.-1-3rd-Ed-1.pdf

Fast Fact #87: Medicare Hospice Benefit – Part 2: Places of Care and Funding
https://www.mypcnow.org/wp-content/uploads/2019/01/FF-87-Medicare-Hospic-2-4th-Ed.pdf

Fast Fact #140: Medicare Hospice Benefit – Levels of Hospice Care
https://www.mypcnow.org/fast-fact/medicare-hospice-benefits-levels-of-hospice-care/

Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org).

Dr. Zara Cooper (@zaracMD) is an acute care surgeon at Brigham and Women’s Hospital where she serves as Kessler Director for the Center of Surgery and Public Health (@csph_bwh). She is a Professor of Surgery at Harvard Medical School, associate faculty at Adriane Labs, and adjunct faculty at the Marcus Institute for Aging Research.

Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.

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Transcript

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0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you
0:12.0	dominate the day.
0:22.4	Are you a passionate surgical educator with something to say?
0:25.6	Then join behind the knife and let the world hear.
0:28.2	Behind the Knife is the number one surgery podcast in the world, with each episode
0:31.4	reaching 20,000 listeners.
0:33.6	Our current group of subspecialty teams have created incredibly diverse and engaging
0:37.8	content, but their commitments are nearly finished and we want to open up the opportunity
0:42.0	to all of our listeners.
0:43.6	We're looking for teams of three to four surgeons who will develop one new subspecialty
0:47.2	podcast every four months.
0:49.5	To learn more, check out the show notes or contact us at hello at BehindTheKnife.org.
0:54.8	Applications are due February 13th.
0:56.9	Hi, everyone.
0:58.4	Welcome back to another surgical palliative care edition of Behind the Knife.
1:03.7	My name is Red Hoffman and I'm an acute care surgeon at Mission Hospital in Asheville,
1:08.5	North Carolina.
1:10.2	And one of about 80 surgeons currently board certified in hospice and palliative medicine.
1:15.2	I'm the founder and host of the surgical palliative care podcast and the co-founder of the
1:20.1	recently launched surgical palliative care society.
1:23.6	And I'd like to introduce, again, my fabulous co-host, Dr. Zara Cooper and Dr. Amanda Stasney.
1:31.4	So Zara is a professor of surgery at Harvard Medical School, the Kessler Director for the
	...

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