Discussing goals of care preoperatively in high-risk oncologic surgery.

Abstract

38 Background: Major oncologic surgery has a high incidence of perioperative morbidity. Despite these risks, most surgeons do not discuss goals of care prior to surgery. This study assessed the feasibility of a preoperative goals of care discussion for high risk oncologic surgery. Methods: Observational study of patients undergoing high risk surgery. Prior to surgery, patients were referred for consultation with a surgeon certified in both Palliative and Critical Care. Consultations followed a semi-structured template (table). Patient and conversation outcomes were assessed, and qualitative analysis of consult notes was performed to identify themes. Results: Twelve patients were approached and 11 participated. Mean time between consultation and surgery was 7 days (1-36). All patients named a health care proxy and expressed goals of care. Most (8/11) specified their preferences for life support. Themes included hope –surgery will return them to independence/home; fear – pain, anxiety; and faith–“it is up to God” as reason for not discussing suboptimal surgical outcomes. One patient declined surgery after discussion and transitioned to hospice. Ten survived to discharge: 6 to home (2 with hospice), 4 to rehab. Conclusions: Preoperative goals of care discussions are feasible for high risk oncologic surgery patients. Eliciting goals of care helped clarify wishes for life sustaining therapy. Goals of care discussions do not destroy hope, but can reveal unrealistic expectations for surgery and outcomes. [Table: see text]