Post‐mortem general surgeon reflection on decision‐making: a mixed‐methods study of mortality audit data

Cattanach, None Daniel E.; Wysocki, Arkadiusz Peter; Ray-Conde, Therese; Nankivell, C.; Allen, Jennifer; North, J. B.

doi:10.1111/ans.14796

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…This reflection is done through Google Forms, where they are not only asked to choose the options, but also to fill out an open-ended answer sheet and the categories of learning difficulties they are experiencing. Exploration activities are carried out using PMA (Post Mortem Analysis) analysis (Cattanach et al, 2018; Goh & Loh, 2013; Kristiansen et al, 2012; Myllyaho et al, 2004; Pan et al, 2019) They were asked about why they had difficulty in learning and how committed they were to overcome the difficulty. The results of data analysis were processed and presented in the form of a fishbone model.…”

Section: Methodsmentioning

confidence: 99%

Strategies for Project Based Learning during the Pandemic: The Benefits of Reflective Learning Approach

Yulhendri,

Prima Sakti,

Sofya

et al. 2023

SAGE Open

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This study explored students’ experiences in online learning using a project-based learning. The exploratory approach was used with postmortem methods, self-assessment, and questionnaires to identify the factors that affect student Learning Orientation and Engagement in project-based learning (PjBL) during the COVID-19 pandemic. The reflection was able to explore positive and negative experiences, as well as the problems the students faced during online learning, particularly in the aspects of teaching. The study population was enrolled in an Economic Education Program that ran from January to June 2021, and consisted of 15 participants. Three core subjects were selected as the sample. This sampling considered the problems that many education stakeholders complained about, that is, the low professional competency of the study program during online learning. This is why the three subjects were chosen as the core subjects in achieving the main competencies for prospective economics teachers. Thus, PjBL was conducted on three subjects: Development Economics, Human Resource Economics, and Development Planning. After the assessment was carried out, the data showed that positive student learning experiences tended to be higher than negative ones, and P21 ability aspects were much higher than critical thinking and collaboration.

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Section: Methodsmentioning

confidence: 99%

Strategies for Project Based Learning during the Pandemic: The Benefits of Reflective Learning Approach

Yulhendri,

Prima Sakti,

Sofya

et al. 2023

SAGE Open

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“…Surgeons are becoming more receptive to shared decision-making when deciding to operate. 33 In Australia and the USA, an audit and survey of surgeons reported that 26% would change the decision to operate in retrospect after a death, 34 and that more than half of surgeons would not operate in the context of a do-not-resuscitate order. 35 However, barriers to ACP in surgery remain and include limited community awareness, reluctance of healthcare professional involvement, 36 the short-term nature of surgical goals and planning, limited education in ACP and the inherent nature of resuscitation in anaesthesia.…”

Section: Implications For Clinicians and Policy Makersmentioning

confidence: 99%

An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals

Keon-Cohen

Story

Moran

et al. 2022

Anaesth Intensive Care

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The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1–2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.

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“…QASM data offer an opportunity to analyse individual surgeons' reflections, to gain a collective understanding of factors that might have led to improved patient outcomes. Cattanach and co‐workers categorized surgeons' reflections on contributors to patient deaths and found that, with the benefit of hindsight, 18 per cent of 2575 surgeons would have managed their patients differently. Operative and clinical management were the most common areas of reflective change.…”

Section: Introductionmentioning

confidence: 99%

Learning from regret

Boyle¹,

Allen

Rey-Conde

et al. 2020

British Journal of Surgery

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Background Death after surgery is infrequent but can be devastating for the surgeon. Surgeons may experience intense emotional reactions after a patient's death, reflecting on their part in the death and the patient's loss of life. Excessive rumination or feelings of regret may have lasting negative consequences, but these reactions may also facilitate learning for future decision‐making. This qualitative study analysed surgeons' reflections on what might have been done differently before a patient's death and explored non‐technical (cognitive and interpersonal) aspects of care as potential targets for improvement. Methods In Australia's Queensland Audit of Surgical Mortality, surgeons reflect on factors surrounding the death of patients in their care and respond to the open‐ended question: in retrospect, would you have done anything differently? Framework analysis was applied to surgeons' responses to identify themes relating to non‐technical aspects of care. Results Responses from 1214 surgeons were analysed. Two main themes were identified. Dilemmas and difficult decisions confirmed the uncertainty, complexity and situational pressures that often precede a surgical death; regret and empathy for patients featured in some responses. In the second main theme, communication matters, surgeons cited better communication, with patients, families, colleagues and at handover, as a source of reflective change to improve decision‐making and reduce regret. Conclusion Surgical decision‐making involves uncertainty, and regret may occur after a patient's death. Enhancing the quality of communication with patients and peers in comprehensive assessment of the surgical patient may mitigate postdecision regret among surgeons.

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Post‐mortem general surgeon reflection on decision‐making: a mixed‐methods study of mortality audit data

Abstract: This mixed-methods study has identified a minority of surgeons proffer retrospective management changes after their patient has died. Of those who do, decision-making around operative management is the most common area of reflective consideration.

Cited by 5 publications

References 40 publications

Strategies for Project Based Learning during the Pandemic: The Benefits of Reflective Learning Approach

Strategies for Project Based Learning during the Pandemic: The Benefits of Reflective Learning Approach

An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals

Learning from regret

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