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Miller CA, Guidry JPD, Kenning KL, Bohl JL, Fuemmeler BF, Rivet EB. Barriers and Facilitators of Colorectal Cancer Screening During the COVID-19 Pandemic. Am Surg 2024:31348241227216. [PMID: 38215211 DOI: 10.1177/00031348241227216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND COVID-19 introduced new barriers to health care including cancer screenings. This study evaluated the role of pandemic- and copay-related barriers to colonoscopy and the extent to which home-based testing methods were utilized. METHODS A cross-sectional survey assessed colorectal cancer (CRC) attitudes and screening early in the COVID-19 pandemic. RESULTS Respondents (342; 50.37% female) were 62.32 (SD = 6.87) years old. Roughly half were White/Caucasian (329; 48.45%); 29.75% were Black/African American (202); and 21.80% were another race (148). Roughly two-thirds were up-to-date with CRC screening (459; 67.59%). In an adjusted model, those with a higher agreement that concerns about COVID-19 delayed scheduling their colonoscopy (OR = .79; 95% CI: .08, .63; P = .045) and concerns about copays delayed scheduling their colonoscopy (OR = .73; 95% CI: .73, .57; P = .02) were less likely to be up-to-date on screening. In another adjusted model, those screened during the pandemic were significantly more likely to be screened via an at-home test (OR = 10.93; 95% CI: 5.95, 20.27; P < .001). DISCUSSION During the COVID-19 pandemic, screening copay-related concerns persisted and were significantly higher among those not up-to-date with CRC screening. Increased at-home testing and addressing copay barriers may increase CRC screening adherence now and in future infectious disease outbreaks.
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Affiliation(s)
- Carrie A Miller
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeanine P D Guidry
- Robertson School of Media and Culture, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jaime L Bohl
- Department of Colon and Rectal Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Bernard F Fuemmeler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Emily B Rivet
- Department of Colon and Rectal Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Rivet EB, Edwards C, Lange P, Haynes S, Feldman M, Cholyway R. Letter re: Response to Response to Telehealth Training for Surgeons to Empathetically Deliver Bad News via Video Mediated Communication. Am Surg 2023; 89:6437. [PMID: 34806907 DOI: 10.1177/00031348211056270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emily B Rivet
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Cherie Edwards
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
- Office of Assessment, Evaluation and Scholarship, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Patricia Lange
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Susan Haynes
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Moshe Feldman
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
- Office of Assessment, Evaluation and Scholarship, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Renee Cholyway
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
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Rivet EB, Feldman M, Khandelwal S, Anderson A, Bedros N, Haynes S, McDonough E, Cholyway R, Lange P, Edwards C, Santen SA. Adapting Compassionate Conversations for Virtual Mediated Communication. J Surg Educ 2023; 80:1296-1301. [PMID: 37423804 DOI: 10.1016/j.jsurg.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The Covid-19 pandemic resulted in a shift in communication of difficult, emotionally charged topics from almost entirely in-person to virtual mediated communication (VMC) methods due to restrictions on visitation for safety. The objective was to train residents in VMC and assess performance across multiple specialties and institutions. DESIGN The authors designed a teaching program including asynchronous preparation with videos, case simulation experiences with standardized patients (SPs), and coaching from a trained faculty member. Three topics were included - breaking bad news (BBN), goals of care / health care decision making (GOC), and disclosure of medical error (DOME). A performance evaluation was created and used by the coaches and standardized patients to assess the learners. Trends in performance between simulations and sessions were assessed. SETTING Four academic university hospitals - Virginia Commonwealth University Medical Center in Richmond, Virginia, The Ohio State University Wexner Medical Center in Columbus, Ohio, Baylor University Medical Center in Dallas, Texas and The University of Cincinnati in Cincinnati, Ohio- participated. PARTICIPANTS Learners totaled 34 including 21 emergency medicine interns, 9 general surgery interns and 4 medical students entering surgical training. Learner participation was voluntary. Recruitment was done via emails sent by program directors and study coordinators. RESULTS A statistically significant improvement in mean performance on the second compared to the first simulation was observed for teaching communication skills for BBN using VMC. There was also a small but statistically significant mean improvement in performance from the first to the second simulation for the training overall. CONCLUSIONS This work suggests that a deliberate practice model can be effective for teaching VMC and that a performance evaluation can be used to measure improvement. Further study is needed to optimize the teaching and evaluation of these skills as well as to define minimal acceptable levels of competency.
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Affiliation(s)
- Emily B Rivet
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
| | - Moshe Feldman
- School of Medicine, McGlothlin Medical Education Center, Virginia Commonwealth University, Richmond, Virginia
| | - Sorabh Khandelwal
- Department of Emergency Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Aaron Anderson
- Department of Theatre, Virginia Commonwealth University, Richmond, Virginia
| | - Nicole Bedros
- Urgent Surgery Associates, Baylor University Medical Center, Dallas, Texas
| | - Susan Haynes
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Erin McDonough
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Renee Cholyway
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Patricia Lange
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Cherie Edwards
- School of Medicine, McGlothlin Medical Education Center, Virginia Commonwealth University, Richmond, Virginia
| | - Sally A Santen
- School of Medicine, McGlothlin Medical Education Center, Virginia Commonwealth University, Richmond, Virginia
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Rivet EB, Edwards C, Lange P, Haynes S, Feldman M, Cholyway R. Telehealth Training for Surgeons to Empathetically Deliver Bad News Via Video-Mediated Communication. Am Surg 2023; 89:440-446. [PMID: 34228939 DOI: 10.1177/00031348211030458] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a sudden increase in the need to effectively use telehealth in all realms of health care communication, including the delivery of bad news. METHODS A single arm, unblinded, feasibility study was performed at a tertiary care center located in Central Virginia to explore the value and utility of providing a telehealth training program based on SPIKES to teach surgical residents and faculty best practice for disclosing difficult news via video-mediated communication (VMC). Surgical interns (categorical and preliminary), surgical residents, and surgical faculty from General, Neuro, Pediatric, Plastics, Oncology, Urology, and Vascular surgical specialties were recruited via email to voluntarily participate in a telehealth simulation-based workshop, with 33 surgical learners participating in the training and 28 completing evaluation surveys. RESULTS Only six respondents (22%) indicated they had prior formal training on telehealth communication with patients or families, while 13 (46%) said they had prior experience giving bad news via telehealth. Comments about improving the training focused on providing more scenarios to practice and more time for feedback. Overall, 25 learners (86%) agreed the activity was a valuable learning experience and the majority (61%) of responses were positive for future use of telehealth for breaking bad news. DISCUSSION Practicing communication skills with VMC was found to be valuable by surgical interns, residents, and faculty. Formal training should be provided for surgeons at every stage of training and practice to improve skill in the delivery of bad news to patients and their families.
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Affiliation(s)
- Emily B Rivet
- Department of Surgery, 6887Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Cherie Edwards
- Office of Assessment, Evaluation and Scholarship, 6886Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Patricia Lange
- Department of Surgery, 6887Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Susan Haynes
- Department of Surgery, 6887Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Moshe Feldman
- Office of Assessment, Evaluation and Scholarship, 6886Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Renee Cholyway
- Department of Surgery, 6887Virginia Commonwealth University Health System, Richmond, VA, USA
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Mende-Siedlecki P, Rivet EB, Grover AC, Hagiwara N. Making Meaningful Impacts: Centering Breakdowns in Dyadic Communication Processes in Racial Disparities in Surgical Pain Care. Ann Surg 2022; 276:e646-e648. [PMID: 35762595 PMCID: PMC9749421 DOI: 10.1097/sla.0000000000005516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although pain care decisions unfold as a negotiation between patients and surgeons, previous research has examined patient-level and provider-level factors contributing to racial disparities in surgical pain care in isolation. We call for changes in the investigations of such racial disparities at the levels of conceptualization, research design, analysis, and research team composition.
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Affiliation(s)
| | - Emily B. Rivet
- Department of Surgery, School of Medicine, Virginia Commonwealth University
| | - Amelia C. Grover
- Department of Surgery, School of Medicine, Virginia Commonwealth University
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University
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Rivet EB, Edwards C, Bedros N, Haynes S, Anderson A, McDonough E, Khandelwal S, Cholyway R, Feldman M, Lange P. From chaos to creativity: Designing collaborative communication training for the delivery of bad news. Surgery 2022; 172:1323-1329. [PMID: 36008175 PMCID: PMC9395255 DOI: 10.1016/j.surg.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
Background Before the COVID-19 pandemic, teaching communication skills in health care focused primarily on developing skills during face-to-face conversation. Even experienced clinicians were unprepared for the transition in communication modalities necessitated due to physical distancing requirements and visitation restrictions during the COVID-19 pandemic. We aimed to develop and pilot a comprehensive video-mediated communication training program and test its feasibility in multiple institutional settings and medical disciplines. Methods The education team, consisting of clinician-educators in general surgery and emergency medicine (EM) and faculty specialists in simulation and coaching, created the intervention. Surgery and EM interns in addition to senior medical students applying in these specialties were recruited to participate. Three 90-minute sessions were offered focusing on 3 communication topics that became increasingly complex and challenging: breaking bad news, goals of care discussions, and disclosure of medical error. This was a mixed-methods study using survey and narrative analysis of open comment fields. Results Learner recruitment varied by institution but was successful, and most (75%) learners found the experience to be valuable. All of the participants reported feeling able to lead difficult discussions, either independently or with minimal assistance. Only about half (52%) of the participants reported feeling confident to independently disclose medical error subsequent to the session. Conclusion We found the program to be feasible based on acceptability, demand, the ability to implement, and practicality. Of the 3 communication topics studied, confidence with disclosure of medical error proved to be the most difficult. The optimal length and structure for these programs warrants further investigation.
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Affiliation(s)
- Emily B Rivet
- Departments of Surgery and Internal Medicine, Virginia Commonwealth University, Richmond, VA.
| | - Cherie Edwards
- School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Nicole Bedros
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Susan Haynes
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Aaron Anderson
- Department of Theatre, School of Medicine and School of Business, Virginia Commonwealth University, Richmond, VA
| | - Erin McDonough
- Department of Emergency Medicine, College of Medicine, University of Cincinatti, Cincinatti, OH
| | - Sorabh Khandelwal
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Renee Cholyway
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Moshe Feldman
- School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Patricia Lange
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
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Kenning K, Bohl JL, Miller CA, Fuemmeler B, Rivet EB. Covid-19 Pandemic Impact on Colorectal Cancer Screening. J Am Coll Surg 2021. [PMCID: PMC8531696 DOI: 10.1016/j.jamcollsurg.2021.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Rivet EB, Bohl JL, Al Yassin S, Bickston SJ. Palliative Care in Inflammatory Bowel Disease: A New Partnership. Crohns Colitis 360 2021; 3:otab062. [PMID: 36776654 PMCID: PMC9802275 DOI: 10.1093/crocol/otab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Palliative care (PC) is being increasingly recognized for benefitting patients with a wide spectrum of chronic serious medical conditions. Methods Care models and principles of PC for patient with inflammatory bowel disease were explored. Results The use of a structured and systematic approach for emotionally laden conversations and the "Total Pain" paradigm are examples of PC expertise that can be applied through either primary or consultative PC models. Conclusions PC should be considered in clinical practice and as a topic for further scholarly investigation to further define its role and benefits.
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Affiliation(s)
- Emily B Rivet
- Department of Surgery, Division of Colon and Rectal Surgery, Section of Hospice and Palliative Medicine, Virginia Commonwealth University, Richmond, Virginia, USA,Department of Internal Medicine, Division of Colon and Rectal Surgery, Section of Hospice and Palliative Medicine, Virginia Commonwealth University, Richmond, Virginia, USA,Address correspondence to: Emily B. Rivet, MD, MBA, FACS, FASCRS, Department of Surgery and Internal Medicine, Division of Colon and Rectal Surgery, Section of Hospice and Palliative Medicine, Virginia Commonwealth University, 1200 East Broad Street, PO Box 980519, Richmond, VA 23298-0519, USA ()
| | - Jaime L Bohl
- Department of Surgery, Division of Colon and Rectal Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarmed Al Yassin
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Stephen J Bickston
- Department of Internal Medicine, Inflammatory Bowel Disease Center, Virginia Commonwealth University, Richmond, Virginia, USA,Department Gastroenterology, Inflammatory Bowel Disease Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Rivet EB, Blades CE, Hutson M, Noreika D. Chronic and Sudden Serious Illness, COVID-19, and Decision-Making Capacity: Integrating Advance Care Planning Into the Preoperative Checklist for Elective Surgery. Am Surg 2020; 86:1450-1455. [DOI: 10.1177/0003134820965957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Advance Care Planning (ACP) includes anticipating future medical decisions and designating a medical decision maker in the event of losing the capacity to make one’s own medical decisions. Many advantages can be seen to doing ACP before a crisis as well as revisiting these discussions over time as circumstances change. This case presentation is of a 74-year-old woman with multiple medical problems who had ACP discussions in the context of proposed surgery for colon cancer. These conversations highlight the elements of high-quality ACP and the importance of learning what patients mean when they employ phrases commonly referenced in these conversations. The planned surgery was delayed by the COVID-19 pandemic but the discussions helped to guide decision-making when the patient became critically ill with COVID-19.
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Affiliation(s)
- Emily B. Rivet
- Departments of Surgery and Internal Medicine, Virginia Commonwealth University Health System, Richmond, USA
| | - Candace E. Blades
- Virginia Commonwealth University Health System, Advance Care Planning Program, Richmond, USA
| | - Mary Hutson
- Virginia Commonwealth University Health System, Department of Performance Improvement, USA
| | - Danielle Noreika
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, USA
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Affiliation(s)
- Emily B. Rivet
- Division of Bariatric and Gastrointestinal Surgery, Departments of Surgery and Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond
| | - Egidio Del Fabbro
- Division of Hematology, Department of Internal Medicine, Oncology and Palliative Care, Virginia Commonwealth University School of Medicine, Richmond
| | - Paula Ferrada
- Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond
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Suwanabol PA, Kanters AE, Reichstein AC, Wancata LM, Dossett LA, Rivet EB, Silveira MJ, Morris AM. Characterizing the Role of U.S. Surgeons in the Provision of Palliative Care: A Systematic Review and Mixed-Methods Meta-Synthesis. J Pain Symptom Manage 2018; 55:1196-1215.e5. [PMID: 29221845 DOI: 10.1016/j.jpainsymman.2017.11.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT The provision of palliative care varies appropriately by clinical factors such as patient age and severity of disease and also varies by provider practice and specialty. Surgical patients are persistently less likely to receive palliative care than their medical counterparts for reasons that are not clear. OBJECTIVES We sought to characterize surgeon-specific determinants of palliative care in seriously ill and dying patients. METHODS We performed a systematic review of the literature focused on surgery and palliative care within PubMed, CINAHL, EMBASE, Scopus, and Ovid Medline databases from January 1, 2000 through December 31, 2016 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quantitative and qualitative studies with primary data evaluating surgeons' attitudes, knowledge, and behaviors or experiences in care for seriously ill and dying patients were selected for full review by at least two study team members based on predefined inclusion criteria. Data were extracted based on a predetermined instrument and compared across studies using thematic analysis in a meta-synthesis of qualitative and quantitative findings. RESULTS A total of 2589 abstracts were identified and screened, and 35 articles (26 quantitative and nine qualitative) fulfilled criteria for full review. Among these, 17 articles explored practice and attitudes of surgeons regarding palliative and end-of-life care, 11 articles assessed training in palliative care, five characterized surgical decision making, one described behaviors of surgeons caring for seriously ill and dying patients, and one explicitly identified barriers to use of palliative care. Four major themes across studies affected receipt of palliative care for surgical patients: 1) surgeons' experience and knowledge, 2) surgeons' attitudes, 3) surgeons' preferences and decision making for treatment, and 4) perceived barriers. CONCLUSIONS Among the articles reviewed, surgeons overall demonstrated insight into the benefits of palliative care but reported limited knowledge and comfort as well as a multitude of challenges to introducing palliative care to their patients. These findings indicate a need for wider implementation of strategies that allow optimal integration of palliative care with surgical decision making.
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Affiliation(s)
| | - Arielle E Kanters
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ari C Reichstein
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Lauren M Wancata
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily B Rivet
- Department of Surgery and Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Maria J Silveira
- Department of Surgery, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Arden M Morris
- S-SPIRE Center and Department of Surgery, Stanford University, Stanford, California, USA
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Rivet EB, Ferrada P, Albrecht T, Cassel JB, Broering B, Noreika D, Del Fabbro E. Characteristics of palliative care consultation at an academic level one trauma center. Am J Surg 2017; 214:657-660. [PMID: 28689992 DOI: 10.1016/j.amjsurg.2017.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/08/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The current status of palliative care consultation for trauma patients has not been well characterized. We hypothesized that palliative care consultation currently is requested for patients too late to have any clinical significance. METHODS A retrospective chart review was performed for traumatically injured patients' ≥18 years of age who received palliative care consultation at an academic medical center during a one-year period. RESULTS The palliative care team evaluated 82 patients with a median age of 60 years. Pain and end of life were the most common reasons for consultation; interventions performed included delirium management and discussions about nutritional support. For decedents, median interval from palliative care consultation to death was 1 day. Twenty seven patients died (11 in the palliative care unit, 16 in an ICU). Nine patients were discharged to hospice. CONCLUSIONS Most consultations were performed for pain and end of life management in the last 24 h of life, demonstrating the opportunity to engage the palliative care service earlier in the course of hospitalization.
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Affiliation(s)
- Emily B Rivet
- Departments of Surgery and Internal Medicine, VCU School of Medicine, Richmond, VA, USA.
| | - Paula Ferrada
- Department of Surgery, VCU School of Medicine, Richmond, VA, USA.
| | - Tara Albrecht
- VCU School of Nursing and Massey Cancer Center, School of Nursing, Richmond, VA, USA.
| | - J Brian Cassel
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, VCU School of Medicine, Richmond, VA, USA.
| | - Beth Broering
- VCU Medical Center Trauma Program, Richmond, VA, USA.
| | - Danielle Noreika
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, VCU School of Medicine, Richmond, VA, USA.
| | - Egidio Del Fabbro
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, VCU School of Medicine, Richmond, VA, USA.
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Abstract
AIM The study examined the feasibility and potential benefit of ex vivo sentinel lymph node (SLN) mapping, including multilevel sectioning (MLS) and immunohistochemistry (IHC) in colon cancer patients undergoing laparoscopic colectomy. The secondary goals were (i) to identify patient and tumour characteristics that might influence the success of the SLN technique, (ii) to investigate the extent of lymphadenectomy required to encompass tumour-positive nonsentinel lymph nodes (NSLN) and (iii) to ascertain the association of SLN status with oncological outcomes. METHOD SLN mapping was performed after specimen extraction using 1% Isosulfan blue. The SLNs were analysed with H&E staining after MLS, and if negative, IHC was performed. NSLNs were grouped by distance either greater than or less than 4 cm from the tumour. RESULTS Seventy-one patients completed the study between 2003 and 2007. Using H&E with MLS, the accuracy of SLN mapping was 76%, sensitivity was 52% and the false-negative rate was 48%. Excluding patients with clinically positive lymph nodes resulted in a significant improvement in accuracy to 81% and decreased the false-negative rate to 30%. Furthermore, as the only positive NSLN > 4 cm from the tumour was grossly positive, SLN mapping with a 4-cm mesenteric cuff would have given 100% sensitivity in patients without macroscopically involved nodes. CONCLUSIONS SLN mapping may be of value in selected patients. It may be possible to accurately stage patients with a 4-cm cuff of mesentery, although further validation of this proposal is required.
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Affiliation(s)
- E B Rivet
- Bon Secours Hampton Roads Health System, Suffolk, Virginia, USA
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