Publication
Surgery hurts: Characterization of the unmet palliative care needs of surgical patients
Zens T, Kopecky K, Schwarze M, Suwanabol P · Journal of the American College of Surgeons · 2017
INTRODUCTION: The goals of palliative care, which include robust symptom management and psychosocial support, are applicable to many surgical patients. Given this, we sought to identify and characterize unmet palliative care needs for surgical inpatients. METHODS: After an 8-week surgical clerkship, third-year medical students were asked to write reflective essays describing experiences in which they witnessed patient's pain. We then used qualitative content analysis to identify and describe surgical patients' palliative care needs illustrated in essays from academic years 2012 to 2016. RESULTS: Three hundred forty-one essays detailed stories of 331 patients, ages 2 to 82 years, on the general, neurologic, orthopaedic, cardiothoracic, transplant, otolaryngologic, plastic, urologic, pediatric, burn, and trauma surgical services. Students described unmet palliative care needs within 4 domains: physical pain, psy-chosocial pain, ethical issues, and lack of recognition by the care team. Students depicted unanticipated postoperative pain and pain from bedside procedures. They also highlighted debilitating symptoms including nausea, hunger/thirst, and discomfort from drains. Students revealed psychosocial pain including uncertain prognosis, receipt of bad news, prolonged hospitalization and isolation, body image apprehension and loss of dignity. They outlined how communication barriers led to loss of autonomy. Some students noted the care team's inadequate response to pain but others praised surgeons for their emotional support. CONCLUSIONS: There is a broad range of unmet palliative care needs across all surgical subspecialties that are not limited to postoperative incisional pain. This suggests a critical need for surgeons to learn primary palliative care skills to improve patient well being and outcomes.
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