TY - JOUR
T1 - Defining Serious Illness Among Adult Surgical Patients
AU - Lee, Katherine C.
AU - Walling, Anne M.
AU - Senglaub, Steven S.
AU - Kelley, Amy S.
AU - Cooper, Zara
N1 - Funding Information:
The authors would like to thank Dr. R. Sean Morrison for his role in moderating the in-person expert advisory panel meeting and the members of the Surgical Palliative Care Quality Indicators Expert Advisory Panel for their contributions to this project: Scott Bane, JD, MPA, The John A. Hartford Foundation; Rachelle Bernacki, MD, MS, Ariadne Labs and Dana-Farber Cancer Institute; Marcy Carty, MD, MPH, Cityblock Health; Alaina Ena, RN, BSN, MN, Oregon Health Sciences University; Lee A. Fleisher, MD; University of Pennsylvania Health System; Fabian M. Johnston MD, MHS, Johns Hopkins University; Dana Lustbader, MD, Optum and ProHEALTH Care; Ronald V. Maier, MD, American College of Surgeons (ACS) and University of Washington; Anne Mosenthal, MD, Rutgers, New Jersey Medical School; Marcia M. Russell, MD, PhD, ACS Coalition for Quality in Geriatric Surgery and University of California, Los Angeles (UCLA); Thomas K Varghese Jr. MD, MS, ACS Strong for Surgery and University of Utah Huntsman Cancer Institute; Neil Wenger, MD, MPH, David Geffen School of Medicine at UCLA, and RAND Health. This work was made possible by the National Palliative Care Research Center and the Cambia Health Foundation, who jointly sponsored the in-person meeting to develop a serious illness definition and quality indicators for palliative care in surgery. The authors disclose no conflicts of interest.
Funding Information:
This work was made possible by the National Palliative Care Research Center and the Cambia Health Foundation, who jointly sponsored the in-person meeting to develop a serious illness definition and quality indicators for palliative care in surgery.
Publisher Copyright:
© 2019 American Academy of Hospice and Palliative Medicine
PY - 2019/11
Y1 - 2019/11
N2 - Context: Palliative care (PC) for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased health care utilization. However, efforts to integrate PC alongside restorative surgical care are limited by the lack of a consensus definition for serious illness in the perioperative context. Objectives: The objectives of this study were to develop a serious illness definition for surgical patients and identify a denominator for quality measurement efforts. Methods: We developed a preliminary definition including a set of criteria for 11 conditions and health states. Using the RAND-UCLA Appropriateness Method, a 12-member expert advisory panel rated the criteria for each condition and health state twice, once after an in-person moderated discussion, for validity (primary outcome) and feasibility of measurement. Results: All panelists completed both rounds of rating. All 11 conditions and health states defining serious illness for surgical patients were rated as valid. During the in-person discussion, panelists refined and narrowed criteria for two conditions (vulnerable elder, heart failure). The final definition included the following 11 conditions and health states: vulnerable elder, heart failure, advanced cancer, oxygen-dependent pulmonary disease, cirrhosis, end-stage renal disease, dementia, critical trauma, frailty, nursing home residency, and American Society of Anesthesiology Risk Score IV-V. Conclusion: We identified a consensus definition for serious illness in surgery. Opportunities remain in measuring the prevalence, identifying health trajectories, and developing screening criteria to integrate PC with restorative surgical care.
AB - Context: Palliative care (PC) for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased health care utilization. However, efforts to integrate PC alongside restorative surgical care are limited by the lack of a consensus definition for serious illness in the perioperative context. Objectives: The objectives of this study were to develop a serious illness definition for surgical patients and identify a denominator for quality measurement efforts. Methods: We developed a preliminary definition including a set of criteria for 11 conditions and health states. Using the RAND-UCLA Appropriateness Method, a 12-member expert advisory panel rated the criteria for each condition and health state twice, once after an in-person moderated discussion, for validity (primary outcome) and feasibility of measurement. Results: All panelists completed both rounds of rating. All 11 conditions and health states defining serious illness for surgical patients were rated as valid. During the in-person discussion, panelists refined and narrowed criteria for two conditions (vulnerable elder, heart failure). The final definition included the following 11 conditions and health states: vulnerable elder, heart failure, advanced cancer, oxygen-dependent pulmonary disease, cirrhosis, end-stage renal disease, dementia, critical trauma, frailty, nursing home residency, and American Society of Anesthesiology Risk Score IV-V. Conclusion: We identified a consensus definition for serious illness in surgery. Opportunities remain in measuring the prevalence, identifying health trajectories, and developing screening criteria to integrate PC with restorative surgical care.
KW - Delphi methods
KW - RAND-UCLA Appropriateness Method
KW - Surgical palliative care
KW - quality improvement
KW - quality measurement
KW - serious illness
UR - http://www.scopus.com/inward/record.url?scp=85072046152&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2019.08.003
DO - 10.1016/j.jpainsymman.2019.08.003
M3 - Article
C2 - 31404642
AN - SCOPUS:85072046152
SN - 0885-3924
VL - 58
SP - 844-850.e2
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 5
ER -