Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention
IntroductionPatients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred A...
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| Veröffentlicht in: | BMJ open 2017-02, Vol.7 (2), p.e014906-e014906 |
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| creator | Selwood, Amanda Senthuran, Siva Blakely, Brette Lane, Paul North, John Clay-Williams, Robyn |
| description | IntroductionPatients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers. This study aims to evaluate the feasibility of this new model of care, and to determine potential benefits to patients and clinicians.Methods and analysisAfter being assessed for frailty, patients will complete a patient–clinician information engagement survey pretreatment and at 6 months follow-up. Patients (and/or family members) will be interviewed about their experience of care pretreatment and at 3 and 6 months follow-ups. Clinicians will complete a survey on workplace attitudes and engagement both preimplementation and postimplementation of PC-ACP and be interviewed, following each survey, on the implementation of PC-ACP. We will use process mapping to map the patient journey through the surgical care pathway to determine areas of improvement and to identify variations in patient experience.Ethics and disseminationThis study has received ethical approval from Townsville Hospital and Health Service HREC (HREC/16/QTHS/100). Results will be communicated to the participating hospital, presented at conferences and submitted for publication in a peer-reviewed MEDLINE-indexed journal. |
| doi_str_mv | 10.1136/bmjopen-2016-014906 |
| format | Article |
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However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers. This study aims to evaluate the feasibility of this new model of care, and to determine potential benefits to patients and clinicians.Methods and analysisAfter being assessed for frailty, patients will complete a patient–clinician information engagement survey pretreatment and at 6 months follow-up. Patients (and/or family members) will be interviewed about their experience of care pretreatment and at 3 and 6 months follow-ups. Clinicians will complete a survey on workplace attitudes and engagement both preimplementation and postimplementation of PC-ACP and be interviewed, following each survey, on the implementation of PC-ACP. We will use process mapping to map the patient journey through the surgical care pathway to determine areas of improvement and to identify variations in patient experience.Ethics and disseminationThis study has received ethical approval from Townsville Hospital and Health Service HREC (HREC/16/QTHS/100). Results will be communicated to the participating hospital, presented at conferences and submitted for publication in a peer-reviewed MEDLINE-indexed journal.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2016-014906</identifier><identifier>PMID: 28242771</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Advance Care Planning ; Advance directives ; Australia ; Clinical decision making ; Decision Making ; Family ; Feasibility Studies ; Frailty ; Health Services Research ; Heart surgery ; Holistic medicine ; Hospitals ; Humans ; Intensive care ; Interviews ; Multiple organ dysfunction syndrome ; Orthopedics ; Patient Outcome Assessment ; Patient satisfaction ; Patient-Centered Care ; Physicians ; Planning ; Research Design ; Risk Assessment - methods ; Surgeons ; Surgery ; Surgical outcomes ; Surgical Procedures, Operative - adverse effects ; Surveys and Questionnaires ; Terminal Care - methods ; Terminal illnesses ; Tertiary Care Centers ; Vascular surgery</subject><ispartof>BMJ open, 2017-02, Vol.7 (2), p.e014906-e014906</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2017 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b500t-86533cddafc09e5ed054518af9aec6b3fc182676e13a05fcfdb51d35231515293</citedby><cites>FETCH-LOGICAL-b500t-86533cddafc09e5ed054518af9aec6b3fc182676e13a05fcfdb51d35231515293</cites><orcidid>0000-0002-8286-4069</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmjopen.bmj.com/content/7/2/e014906.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmjopen.bmj.com/content/7/2/e014906.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,27551,27552,27926,27927,53793,53795,77603,77634</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28242771$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Selwood, Amanda</creatorcontrib><creatorcontrib>Senthuran, Siva</creatorcontrib><creatorcontrib>Blakely, Brette</creatorcontrib><creatorcontrib>Lane, Paul</creatorcontrib><creatorcontrib>North, John</creatorcontrib><creatorcontrib>Clay-Williams, Robyn</creatorcontrib><title>Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>IntroductionPatients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers. This study aims to evaluate the feasibility of this new model of care, and to determine potential benefits to patients and clinicians.Methods and analysisAfter being assessed for frailty, patients will complete a patient–clinician information engagement survey pretreatment and at 6 months follow-up. Patients (and/or family members) will be interviewed about their experience of care pretreatment and at 3 and 6 months follow-ups. Clinicians will complete a survey on workplace attitudes and engagement both preimplementation and postimplementation of PC-ACP and be interviewed, following each survey, on the implementation of PC-ACP. We will use process mapping to map the patient journey through the surgical care pathway to determine areas of improvement and to identify variations in patient experience.Ethics and disseminationThis study has received ethical approval from Townsville Hospital and Health Service HREC (HREC/16/QTHS/100). Results will be communicated to the participating hospital, presented at conferences and submitted for publication in a peer-reviewed MEDLINE-indexed journal.</description><subject>Advance Care Planning</subject><subject>Advance directives</subject><subject>Australia</subject><subject>Clinical decision making</subject><subject>Decision Making</subject><subject>Family</subject><subject>Feasibility Studies</subject><subject>Frailty</subject><subject>Health Services Research</subject><subject>Heart surgery</subject><subject>Holistic medicine</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Interviews</subject><subject>Multiple organ dysfunction syndrome</subject><subject>Orthopedics</subject><subject>Patient Outcome Assessment</subject><subject>Patient satisfaction</subject><subject>Patient-Centered Care</subject><subject>Physicians</subject><subject>Planning</subject><subject>Research Design</subject><subject>Risk Assessment - methods</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Surgical Procedures, Operative - adverse effects</subject><subject>Surveys and Questionnaires</subject><subject>Terminal Care - methods</subject><subject>Terminal illnesses</subject><subject>Tertiary Care Centers</subject><subject>Vascular surgery</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkk1r3DAQhk1paEKaXxAogl56capv2z0USuhHINBLchayPNrV1pJcyTYE-uOr7W5D2kOpDtLAPPPODHqr6pLgK0KYfNv7XZwg1BQTWWPCOyyfVWcUc15LLMTzJ_FpdZHzDpfDRScEfVGd0pZy2jTkrPpx46cUVxc2KC6ziR4ysil6tHWbbZ1c_obykjaQHt4hjfwyzs7DvI0DglWPi55dDCjakptKDGGuTbkSDEgPqw6mBEYnQNOoQ9h3cWGGtBamFL6sTqweM1wc3_Pq_tPHu-sv9e3XzzfXH27rXmA8160UjJlh0NbgDgQMWHBBWm07DUb2zBrSUtlIIExjYY0dekEGJigjggjasfPq_UF3WnoPw68J9aim5LxODypqp_7MBLdVm7iq0rdpcFME3hwFUvy-QJ6Vd9nAWJaCuGRF2oa2DS8dC_r6L3QXlxTKeopKydqW8e6fVNHimEmCcaHYgTIp5pzAPo5MsNrbQB1toPY2UAcblKpXT7d9rPn96QW4OgCl-r8UfwKDSMDI</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Selwood, Amanda</creator><creator>Senthuran, Siva</creator><creator>Blakely, Brette</creator><creator>Lane, Paul</creator><creator>North, John</creator><creator>Clay-Williams, Robyn</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8286-4069</orcidid></search><sort><creationdate>20170201</creationdate><title>Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention</title><author>Selwood, Amanda ; Senthuran, Siva ; Blakely, Brette ; Lane, Paul ; North, John ; Clay-Williams, Robyn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b500t-86533cddafc09e5ed054518af9aec6b3fc182676e13a05fcfdb51d35231515293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Advance Care Planning</topic><topic>Advance directives</topic><topic>Australia</topic><topic>Clinical decision making</topic><topic>Decision Making</topic><topic>Family</topic><topic>Feasibility Studies</topic><topic>Frailty</topic><topic>Health Services Research</topic><topic>Heart surgery</topic><topic>Holistic medicine</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Interviews</topic><topic>Multiple organ dysfunction syndrome</topic><topic>Orthopedics</topic><topic>Patient Outcome Assessment</topic><topic>Patient satisfaction</topic><topic>Patient-Centered Care</topic><topic>Physicians</topic><topic>Planning</topic><topic>Research Design</topic><topic>Risk Assessment - methods</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Surgical Procedures, Operative - adverse effects</topic><topic>Surveys and Questionnaires</topic><topic>Terminal Care - methods</topic><topic>Terminal illnesses</topic><topic>Tertiary Care Centers</topic><topic>Vascular surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Selwood, Amanda</creatorcontrib><creatorcontrib>Senthuran, Siva</creatorcontrib><creatorcontrib>Blakely, Brette</creatorcontrib><creatorcontrib>Lane, Paul</creatorcontrib><creatorcontrib>North, John</creatorcontrib><creatorcontrib>Clay-Williams, Robyn</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Selwood, Amanda</au><au>Senthuran, Siva</au><au>Blakely, Brette</au><au>Lane, Paul</au><au>North, John</au><au>Clay-Williams, Robyn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>7</volume><issue>2</issue><spage>e014906</spage><epage>e014906</epage><pages>e014906-e014906</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>IntroductionPatients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers. This study aims to evaluate the feasibility of this new model of care, and to determine potential benefits to patients and clinicians.Methods and analysisAfter being assessed for frailty, patients will complete a patient–clinician information engagement survey pretreatment and at 6 months follow-up. Patients (and/or family members) will be interviewed about their experience of care pretreatment and at 3 and 6 months follow-ups. Clinicians will complete a survey on workplace attitudes and engagement both preimplementation and postimplementation of PC-ACP and be interviewed, following each survey, on the implementation of PC-ACP. We will use process mapping to map the patient journey through the surgical care pathway to determine areas of improvement and to identify variations in patient experience.Ethics and disseminationThis study has received ethical approval from Townsville Hospital and Health Service HREC (HREC/16/QTHS/100). Results will be communicated to the participating hospital, presented at conferences and submitted for publication in a peer-reviewed MEDLINE-indexed journal.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>28242771</pmid><doi>10.1136/bmjopen-2016-014906</doi><orcidid>https://orcid.org/0000-0002-8286-4069</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Advance Care Planning Advance directives Australia Clinical decision making Decision Making Family Feasibility Studies Frailty Health Services Research Heart surgery Holistic medicine Hospitals Humans Intensive care Interviews Multiple organ dysfunction syndrome Orthopedics Patient Outcome Assessment Patient satisfaction Patient-Centered Care Physicians Planning Research Design Risk Assessment - methods Surgeons Surgery Surgical outcomes Surgical Procedures, Operative - adverse effects Surveys and Questionnaires Terminal Care - methods Terminal illnesses Tertiary Care Centers Vascular surgery |
| title | Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention |
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