Improving Perioperative Goals of Care Communication for Urologic Serious Illness Care.

INTRODUCTION

Care for urologic serious illness often includes surgery; preoperative shared decision making about patient goals of care is a cornerstone of good surgical quality of care.

OBJECTIVE

To understand perspectives on improving perioperative communication about goals of care through a team approach for patients facing urologic serious illness.

METHODS

We conducted 38 semi-structured interviews with Palliative Care Physicians (PC) (12), Urologists (13) and interdisciplinary clinicians (13) at fourteen geographically distributed Veteran Health Administration (VHA) sites. The analytic approach consisted of content analysis with dual review.

RESULTS

We identified five unique themes: 1) Preoperative workflows may benefit from additional patient education as "patients are not [always] aware that we might be able to palliate their symptoms without surgery" 2) The goal of surgery is often something patients really need help understanding, e.g. "It's gonna help temporarily, but it's not gonna help long term" 3) PC is not in the position to clarify the goal of the surgery: "it's very hard for nonsurgeon to have robust a goals of care discussion with the patient who's co-managed with surgery unless surgery is able to give you a sense of what to expect." 4) A team approach to clarifying and navigating patient goals is warranted: "how do we work together to … [set] sort of real realistic expectations and goals for after the surgery?" 5) In coordination, Urologists and PC can offer complementary contributions to different parts of a goals of care conversation based on their expertise.

CONCLUSION

This work is an important initial step towards clarifying a PC-Urology team approach to goals of care and surgery conversations.