When doctors integrate palliative care into presurgical planning, more people who went in for cancer-related surgery were able to put advanced directives in place.
Karleen F. Giannitrapani, PhD, a researcher at the Center for Innovation to Implementation at the Palo Alto Health Care System, wrote a commentary about a study that came out Nov. 7 in JAMA Network Open. The commentary article was published the same day in the same journal.
In the study, the researchers studied the results of integrating a palliative care consultation into normal workflows before surgery among high-risk people with cancer who were going to have surgery. The integration resulted in higher rates of advanced directives.
“Eliciting and documenting high-risk patients’ goals, particularly in advance of a surgical procedure, is central to advanced care planning and definitionally good quality care,” Giannitrapani wrote.
The process change before surgery utilized preoperative checklists, physician training and electronic health records. Doing so demonstrated that improving perioperative goals of care documentation is possible, Giannitrapani wrote.
“These findings are notable because although the study consisted of a small sample in a single cohort, it diverged from other contemporary studies that have failed to demonstrate a clear benefit of perioperative palliative care integration,” Giannitrapani added.
The workflow change being linked to measurable outcomes in terms of increased advanced directives opens up a new line of questions.
Giannitrapani questioned if the shared system of accountability across disciplines in the electronic health record was responsible for the association. She said there may have been some aspect of leadership support that made the increase in advanced directives so successful, or the fact that it involved multiple disciplines of the oncology practice.
Other research shows there are six aspects to foster collaboration between surgeons and palliative care professionals: Mutual trust, respect, perceived usefulness, aligned clinical objectives, organization and communication.
“Outside of serious illness communication and advanced care planning, good quality surgical care is inherently interdisciplinary,” Giannitrapani wrote.
“Goals of care communication may be outside the comfort zone of many in the surgical practice community; however, this skill sits squarely in the wheelhouse of palliative care disciplinary expertise. To achieve better communication-related outcomes, teaming across disciplines and incorporating palliative care early must be strategic,” she added.
