Surgery Residents' Experiences With Seriously-Ill and Dying Patients: An Opportunity to Improve Palliative and End-of-Life Care

Pasithorn A Suwanabol; C Ann Vitous; Chithra R Perumalswami; Sylvia H Li; Nicholas Raja; Brendan R Dillon; Christina W Lee; Jane Forman; Maria J Silveira

doi:10.1016/j.jsurg.2019.12.013

Surgery Residents' Experiences With Seriously-Ill and Dying Patients: An Opportunity to Improve Palliative and End-of-Life Care

J Surg Educ. 2020 May-Jun;77(3):582-597. doi: 10.1016/j.jsurg.2019.12.013. Epub 2020 Feb 14.

Authors

Pasithorn A Suwanabol¹, C Ann Vitous², Chithra R Perumalswami³, Sylvia H Li⁴, Nicholas Raja⁴, Brendan R Dillon⁴, Christina W Lee⁵, Jane Forman⁶, Maria J Silveira⁷

Affiliations

¹ Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: pasuwan@med.umich.edu.
² Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
³ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan.
⁴ University of Michigan Medical School, Ann Arbor, Michigan.
⁵ Department of Surgery, University of British Columbia, Vancouver, Canada.
⁶ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management, Ann Arbor Veterans Affairs Health, Ann Arbor, Michigan.
⁷ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

PMID: 32063510
DOI: 10.1016/j.jsurg.2019.12.013

Abstract

Objective: To describe how and when surgery residents provided primary palliative care and engaged specialty palliative care services.

Design: Phase I consisted of a previously validated survey instrument supplemented with additional questions. We then conducted semistructured interviews with a subset of the survey respondents (Phase II). Using thematic analysis, we characterized surgery residents' perceptions of palliative care delivery among surgical patients.

Setting: General surgery residency programs across the state of Michigan.

Participants: General surgery residents across the state of Michigan. All residents in participating programs were invited to complete the survey in Phase I. Phase II consisted of a subset of the survey respondents who underwent semistructured interviews. Interview respondents were sampled to reflect the overall surveyed group.

Results: Among 119 survey respondents (response rate 70%), all had encountered a palliative care specialist but only 58.8% had been taught when to consult or to refer to palliative care. Survey respondents reported on a multitude of barriers within the clinician, patient and family, and systemic domains. Interviews expanded on survey findings and 4 influential factors of palliative care delivery emerged: (1) Resident Education and Training; (2) Resident Attitudes Toward Palliative Care; (3) Knowledge of Palliative Care; and (4) Training within a Surgical Culture.

Conclusions: This study reveals how surgery resident training and experiences impact palliative and end-of-life care for surgical patients at teaching institutions. Knowledge of how and when residents are providing primary palliative care and engaging with palliative care services will inform future knowledge and behavioral interventions for trainees who often provide care for patients nearing the end of life.

Keywords: education; end-of-life care; palliative care; palliative surgery; resident; surgeon; surgery; surgical patients.

MeSH terms

Humans
Internship and Residency*
Michigan
Palliative Care
Patients
Terminal Care*