Facilitators and Barriers to Recruiting Surgeons into Hospice and Palliative Medicine Training

Salyer, Chelsea; McCammon, Susan; Bassette, Emma; Landzaat, Lindy; Spoozak, Lori; Brooks, Joanna Veazey

doi:10.1016/j.jpainsymman.2023.01.005

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…[34][35][36][37][38][39][40] Fellowship-trained geriatric surgeons may be optimal for a trauma service with a growing cohort of GTPs, but obstacles to this focused training, including financial impact to the surgeon returning to fellowship training and time required to train, limit growth in this specialty. 41 We used a nursing team to provide oversight of the time required for end-of-life discussions and palliative education in the frailest patients (FRAIL score, 5).…”

Section: Discussionmentioning

confidence: 99%

“…There may be some potential benefits in selected outcomes, such as advance care planning and multidisciplinary care, but overall, the studies have identified the need for additional review of clinical and cost effectiveness of geriatricians in the trauma setting 34–40 . Fellowship-trained geriatric surgeons may be optimal for a trauma service with a growing cohort of GTPs, but obstacles to this focused training, including financial impact to the surgeon returning to fellowship training and time required to train, limit growth in this specialty 41 . We used a nursing team to provide oversight of the time required for end-of-life discussions and palliative education in the frailest patients (FRAIL score, 5).…”

Section: Discussionmentioning

confidence: 99%

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GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Wintz,

Schaffer,

Hites

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Considering resources for comprehensive geriatric care, it would be beneficial for geriatric trauma patients (GTPs) and medical patients to be comanaged in one program focusing on ancillary therapeutics (AT): physical therapy, occupational therapy, speech language pathology, respiratory therapy, and sleep wake hygiene. This pilot study describes outcomes of GTPs in a hospital-wide program focused on geriatric-specific AT. METHODS Geriatric trauma patients and geriatric patients were screened by program coordinator for enrollment at one Level II trauma center from August 2021 to December 2022. Enrolled patients (EPs) were admitted to trauma or medicine floors and received repetitive AT with attention to sleep wake hygiene throughout hospitalization and compared with similar nonenrolled patients (NEPs). Excluded patients had any of the following: indication of geriatric syndrome with a fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) score of 5, no frailty with a FRAIL score of 0, comfort focused plans, or arrived from skilled care. Retrospective chart review of demographics and outcomes was completed for both EPs and NEPs. RESULTS A total of 224 EPs (28 trauma [TR]) were compared with 574 NEPs (148 TR). Enrolled patients showed shorter length of stay (mean, 3.8 vs. 6.1; p = 0.0001), less delirium (3.1% vs. 9.6%, p = 0.00222), less time to ambulation (13 hours vs. 39 hours, p = 0.0005), and higher likelihood to discharge home (56% vs. 27%, p < 0.0001) as compared with NEPs. The median FRAIL score was 3 for both groups. Enrolled medical patients ambulated the soonest at 11 average hours, compared with 23 hours for enrolled trauma patients and 39 hours for NEPs. There were zero delirium events among enrolled trauma patients; 25% was found among nonenrolled trauma patients (p = 0.00288). CONCLUSION Despite a small trauma cohort, results support feasibility to include GTPs in hospital-wide programs with geriatric-specific AT. Mobility and cognitive strategies may improve opportunities to avoid delirium, decrease length of stay, and influence more frequent disposition to home. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Wintz,

Schaffer,

Hites

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Sensitizing medical professionals and caregivers to the palliative surgery's role in cancer care Effective cancer care necessitates not only the development of infrastructure for palliative surgery and the training of surgeons in its principles, 1,2 but also the education and awareness of nonsurgeon medical professionals and caregivers about its critical role and significance. Palliative surgery remains underutilized by nonsurgeon clinicians and paramedical staff due to the complexity of metrics that define its successful outcomes.…”

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confidence: 99%

Sensitizing medical professionals and caregivers to the palliative surgery's role in cancer care

Kaul¹,

Garg²

2023

Journal of Surgical Oncology

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Facilitators and Barriers to Recruiting Surgeons into Hospice and Palliative Medicine Training

Cited by 2 publications

References 11 publications

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

GIFTS: Geriatric Intensive Functional Therapy Sessions—for the older trauma patient

Sensitizing medical professionals and caregivers to the palliative surgery's role in cancer care

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