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17 juni 2020

To Face Coronavirus Disease 2019, Surgeons Must Embrace Palliative Care - JAMA

To Face Coronavirus Disease 2019, Surgeons Must Embrace Palliative Care - JAMA

28-04-2020; 10.1001/jamasurg.2020.1698
By: Cooper, et al.

Aim: Describe key elements of palliative care for surgeons during covid-19

Keys:

  • Palliative care is not synonymous for end-of-life care, in the current pandemic everybody should receive palliative care
  • 4 essential elements for surgical supportive care are: (1) using serious-illness communication strategies to disclose prognosis and establish goals of care; (2) treating total pain, (3) caring for the family unit, and (4) supporting clinicians.

Summary:

  • To stem escalation of COVID-19, the WHOn has called for the deferral of elective surgery to divert personnel and equipment to patients with COVID-19.
  • Palliative care is a humanistic and interdisciplinary approach to care focused on prevention and relief of pain and distress in serious illness, and it is associated with improved outcomes for hospitalized patients and their families. It is not restricted to end-of-life care and should also be delivered alongside short or long-term life prolonging care
  • Key elements of surgical palliative care:

     

    • Using serious-illness communication strategies to disclose prognosis and establish goals of care

       

      • Elective surgery has been postponed → only the most severely ill patients will be on the ward. Skills in breaking bad news, disclosing prognosis and establishing goals of care are essential.
      • Especially discussion of resuscitation code and it’s ill prognosis in frail patients should be discussed.
    • Treating total pain

       

      • Not only physical pain, but also psychological, social (less visitors during covid-19, dehumanized interaction with physicians, economic uncertainty), emotional and spiritual pain should be addressed.
      • Proactively include social-workers
    • Caring for the family unit

       

      • Palliative care is rooted in the principle that the family, defined as persons the patient would include in their care team, is the unit of care. In the current time not possible.
      • Patients and families should be given tools to communicate with each other and clinicians.
    • Supporting clinicians

      For health care workers: personal and professional challenges to clinicians who may be called to operate outside their specialty, work under adverse conditions, and care for colleagues and loved ones who are critically ill and who may harbor concern about harming their family and fear dying themselves.

      • Institutional support is required