scholarly journals Patient and Caregiver Understanding of Prognosis After Hip Fracture

2018 ◽  
Vol 21 (3) ◽  
pp. 274-283 ◽  
Author(s):  
Rachel Eikelboom ◽  
Anna R. Gagliardi ◽  
Rajiv Gandhi ◽  
Christine Soong ◽  
Peter Cram
Keyword(s):  
Quality Improvement ◽  
Functional Recovery ◽  
Older Patients ◽  
Treatment Options ◽  
Decision Makers ◽  
Improvement Program ◽  
Surgical Risk ◽  
Academic Hospitals ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

BackgroundHip fracture (HF) is common and requires communication between patient, family, surgeons, and hospitalists. Patient and family understanding of the seriousness of HF is unclear.MethodsWe interviewed older patients (age > 65 years) hospitalized with HF at two Canadian academic hospitals, or their surrogate decision-makers (SDMs). We used qualitative methods to explore understanding of HF treatment options and prognosis. Participants estimated probability of mortality and living independently 30 days after surgery. Results were compared with estimates from the National Surgery Quality Improvement Program (NSQIP) surgical risk calculator.Results9 patients and 3 SDMs were interviewed. Mean age of 12 patients was 82.5 years (75% female). Participants were uncertain about recovery timeline and degree of functional recovery, as well as content and duration of rehabilitation. Participants’ mean estimated 30-day mortality of 6.7% did not differ significantly from estimated mortality predicted by NSQIP (7.5%; p = .88). Participants’ mean estimated probability of living independently 30 days after surgery was 90.8% (range 65–100%).ConclusionsOlder patients and SDMs lack understanding about prognosis and functional recovery even after providing informed consent for HF surgery. Clinical teams should improve communication of prognosis and recovery information to patients and surrogates.

Effective Palliative Care in the Trauma Setting

2020 ◽  
Vol 86 (11) ◽  
pp. 1441-1444
Author(s):  
Kristen L. Schultz ◽  
Karen J. Brasel ◽  
David H. Zonies ◽  
Mackenzie R. Cook
Keyword(s):  
Palliative Care ◽  
Exploratory Laparotomy ◽  
Decision Makers ◽  
Surgical Team ◽  
Improvement Program ◽  
Worst Case ◽  
American College Of Surgeons ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

A 55-year-old man undergoes emergent exploratory laparotomy and splenectomy following a motorcycle collision. Following surgery, he is found to have a traumatic brain injury requiring decompressive craniectomy and intracranial pressure monitoring. The patient then continues to have complications throughout his hospital course. Using the American College of Surgeons Trauma Quality Improvement Program guidelines, the surgical team has early and ongoing primary palliative care discussions to foster communication and determine goals of care for the patient. As the patient deteriorates, the surgical team continues meeting with the patient’s surrogate decision makers to discuss the best case and worst case scenarios regarding the patient’s prognosis and expected quality of life.

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

scholarly journals “It’s not just what the doctor tells me:” Factors that influence surrogate decision-makers’ perceptions of prognosis*

2010 ◽  
Vol 38 (5) ◽  
pp. 1270-1275 ◽  
Author(s):  
Elizabeth A. Boyd ◽  
Bernard Lo ◽  
Leah R. Evans ◽  
Grace Malvar ◽  
Latifat Apatira ◽  
...  
Keyword(s):  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

scholarly journals Impact of a Decision Aid on Surrogate Decision-Makers' Perceptions of Feeding Options for Patients With Dementia

2013 ◽  
Vol 14 (2) ◽  
pp. 114-118 ◽  
Author(s):  
E. Amanda Snyder ◽  
Anthony J. Caprio ◽  
Kathryn Wessell ◽  
Feng Chang Lin ◽  
Laura C. Hanson
Keyword(s):  
Decision Aid ◽  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Surrogate Decision
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