Development and perception of surgery-specific goals of care discussions in the preoperative setting: A learning pilot

Allison S. Letica-Kriegel, Roni Rosen, Nita McNeil, Errika Thompson, Monique James, Vance Broach, Kara Long Roche, Michaela Riportella, Susan Ng, Camila Bernal, Max Vaynrub, Robert Downey, Louis Voigt, Andrew S. Epstein, Judith Nelson, Deborah Goldfrank, Garrett M. Nash

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Goals of care discussions are infrequently documented in the preoperative period. Furthermore, documentation does not consistently address what matters most to patients, although patient values (PV) are central to person-centered care. Methods: A multidisciplinary working group was formed. An electronic note comprised of (1) topics of discussion, (2) PV, and (3) advance care planning (ACP), was created and embedded into existing note templates for Gynecologic Surgical Oncology. Surgeons and advanced practice providers (APPs) were educated to conduct and document these conversations in preoperative clinic for patients undergoing cancer surgery for a pilot period. Data were collected regarding usage of the template. Focus groups with surgeons, APPs, and patients were conducted. Qualitative analysis was performed on transcripts. Results: During the pilot, 7 surgeon/APP teams utilized the template on a total of 55 notes. Average number of notes completed per surgeon was 7.8 (SD 8.5). Forty-six notes (84%) included topics of discussion, 15 (27%) included PV, 4 (7%) included ACP. Qualitative analysis of focus group transcripts revealed that clinicians and patients perceived the initiative to be useful and important, although implementation barriers were identified. Conclusion: Creating a surgery-specific GOC template is feasible. Iterative revisions are needed to increase utility in clinic workflows.

Original languageEnglish
JournalJournal of Surgical Oncology
DOIs
StateAccepted/In press - 2024
Externally publishedYes

Keywords

  • advance care planning
  • patient values
  • person-centered care
  • surgical goals of care
  • surgical palliative care

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