Constructing High-stakes Surgical Decisions: It's Better to Die Trying. Issue 1 (January 2016)

• Record Type: Journal Article
• Authors: Nabozny, Michael J.; Kruser, Jacqueline M.; Steffens, Nicole M.; Brasel, Karen J.; Campbell, Toby C.; Gaines, Martha E.; Schwarze, Margaret L.
• Is Part Of: Annals of surgery. Volume 263:Issue 1(2016:Jan.)
• Publication Date: 2016-01
• Subjects: communication -- end-of-life -- ethics -- high-risk surgery -- palliative care -- surgical decision making; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001081
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To explore high-stakes surgical decision making from the perspective of seniors and surgeons. Background: A majority of older chronically ill patients would decline a low-risk procedure if the outcome was severe functional impairment. However, 25% of Medicare beneficiaries have surgery in their last 3 months of life, which may be inconsistent with their preferences. How patients make decisions to have surgery may contribute to this problem of unwanted care. Methods: We convened 4 focus groups at senior centers and 2 groups of surgeons in Madison and Milwaukee, Wisconsin, where we showed a video about a decision regarding a choice between surgery and palliative care. We used qualitative content analysis to identify themes about communication and explanatory models for end-of-life treatment decisions. Results: Seniors (n = 37) and surgeons (n = 17) agreed that maximizing quality of life should guide treatment decisions for older patients. However, when faced with an acute choice between surgery and palliative care, seniors viewed this either as a choice between life and death or a decision about how to die. Although surgeons agreed that very frail patients should not have surgery, they held conflicting views about presenting treatment options. Conclusions: Seniors and surgeons highly value quality of life, but this notion is difficult to incorporate in acute surgical decisions. Some seniors use these values to consider a choice between surgery and palliative care, whereas others view this as a simple choice between life and death. Surgeons acknowledge challenges framing decisions and describe a clinical momentum that promotes surgical intervention. Abstract : Supplemental Digital Content is available in the text