Susan Mccammon
41 posts
This whole thread is pure joy!
Debbie Mia @ Likely a Nap@TheDebbieMia
The internet is magic sometimes.
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Susan Mccammon retweetledi
Surgical Palliative Care: Considerations for Career Development in Surgery and Hospice and Palliative Medicine facs.org/education/divi…
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Just because our time here for the tweet chat has ended does not mean that the discussion has to! Please continue to comment using the hashtag #EthicsChat and we will retweet your content. Thank you again @DrSabha, @sdmccammon, & @ScottSchweikart for your time and valued insight.
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@JournalofEthics Some reseach has shown that patients may make decisions about procedures based on the quality of the doctor patient relationship rather than any statistical survival data. #LouiseDavies
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"Trust is essential."
-Dr @sdmccammon
#EthicsChat
Susan Mccammon@sdmccammon
@JournalofEthics Because the patient may be under general anesthesia during the operation, surgeons and patients often have to talk about contingencies and intraoperative decision making. Not every finding can be anticipated preoperatively, so trust is essential.
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@JournalofEthics Because the patient may be under general anesthesia during the operation, surgeons and patients often have to talk about contingencies and intraoperative decision making. Not every finding can be anticipated preoperatively, so trust is essential.
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Time flies when you're having fun! Our last question: Informed consent happens all over health care but is regarded as ‘covenantal’ when taking place between patients and surgeons. Why is this and how might it help us think more powerfully about palliative surgery? #EthicsChat
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@JournalofEthics The AMA also acknowledges that palliative care is useful in chronic illnesses with high symptom burden, even if patients are not at the end of life.
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Yes! Here is an article that speaks more to that from our issue this month: journalofethics.ama-assn.org/article/ama-co… #EthicsChat
Susan Mccammon@sdmccammon
@JournalofEthics Also, the AMA HOD emphasizes the importance of training in generalist palliative care for all medical providers and this helps lead to policies that can fund that training.
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@JournalofEthics Also, the AMA HOD emphasizes the importance of training in generalist palliative care for all medical providers and this helps lead to policies that can fund that training.
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Great answers, everyone! Now, for Q9: Physical, emotional, psychological, and spiritual benefits of palliative care are recognized in the #AMA Code of Medical Ethics and in #AMA House of Delegates policy. Which ‘pearls’ from these resources do you recommend? #EthicsChat
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@JournalofEthics Again, the right of every patient to be cared for in a way that acknowledges and addresses suffering.
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@DrSabha @JournalofEthics Absolutely--Dr. Ganai--we need to aim our research and clinical work at achieving goals that are important to patients.
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@JournalofEthics Greater Evaluation of Patient-Reported Outcomes after elective surgeries.
Using that feedback loop to improve clinical care, we can shift focus of "surgical success" to the patient.
#EthicsChat
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Q8: Which ethical and clinical priorities should guide progress and innovation in palliative care practice and research? #EthicsChat
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@JournalofEthics Justice is extremely important. Right now, there are many people who do not have access to high quality palliative care. Or the care they can access does not know how to communicate effectively in different cultures. #RonitElk
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@JournalofEthics Ensuring diversity in the palliative care workforce is essential.
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Q7: How should palliative care training be reformed over the short- and long-term? #EthicsChat
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@JournalofEthics Good palliative care takes time and the pace of modern western biomedicine allows very little margin for time investment. Training and practice and self awareness are important, but often time is the rate limiting factor.
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@JournalofEthics It is important to communicate clearly that the data we have for survival outcomes for high risk operations are often limited. Those statistics are often not that helpful for patients to imagine possible outcomes.
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Q6: Clear communication is always clinically and ethically key. What are best practices for decision-sharing about palliative surgery? #EthicsChat
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@JournalofEthics Scenario planning, like the Best case-worst case decision tool developed by Dr. Schwarze's lab in WI.
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@JournalofEthics The success of a palliative intervention has to be determined by the patient's goals--relief of pain, ability to go home, fewer days in hospital, management of a difficult wound....
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Q5: In which ethical and clinical terms ought we determine whether, when, and for whom surgical interventions are successful? #EthicsChat
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@JournalofEthics In terms of ethical principlism, I think beneficence and nonmaleficence are predominant. Calculating and minimizing acceptable harms.
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@ScottSchweikart @JournalofEthics Most curative intent operations are palliative to some degree--they relieve symptoms. But some are not--my father had an open repair of an asymptomatic AAA and that was to prevent future suffering.
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@JournalofEthics ...with false expectations that it is a curative surgery. #EthicsChat
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Q4: What does it mean for clinicians to intend an intervention to be both curative and palliative? #EthicsChat
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@JournalofEthics Beyond the intended outcome (cure or relief), the term "curative intent" also includes the level of risk or comorbidity we are willing to accept from a treatment.
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@JournalofEthics Absolutely Dr. Ganai--this is why it is so important to have surgeons who are trained in discussing palliative goals of care.
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Facts, Dr. Ganai! Love the order that you listed this in. Priceless content. #EthicsChat
Sabha Ganai MD PhD MPH FACS FSSO 🐲🇵🇸@DrSabha
@JournalofEthics The patient! And the surgeon! And the patient! This is a fundamental area of negotiation requiring a patient-surgeon relationship and a good understanding of relevant disease, prognosis, all taken in perspective of the patient. #EthicsChat
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