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Supporting surgical residents learning clinical palliative care: Insights from multi-disciplinary focus groups

  • Kristen Schultz
    Correspondence
    Corresponding author. Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
    Affiliations
    Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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  • Shannon Howard
    Affiliations
    Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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  • Timothy Siegel
    Affiliations
    Department of Medicine, Division of Hematology / Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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  • David Zonies
    Affiliations
    Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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  • Karen Brasel
    Affiliations
    Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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  • Mackenzie Cook
    Affiliations
    Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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  • Kirstin Moreno
    Affiliations
    Office of Educational Improvement Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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Published:February 28, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.02.062

      Highlights

      • Primary Palliative Care by the primary team is essential to high quality care.
      • 8 multi-professional focus groups with 34 total individuals, qualitative approach.
      • Surgical resident engagement in palliative care can be maximized by starting their involvement in a pre-operative setting.
      • A focused curriculum to build basic palliative care skills is needed.

      Abstract

      Background

      A shortage of palliative care (PC) sub-specialists highlights the need for quality PC provided by treating surgeons, although no established curriculum exists to teach surgical residents PC skills. To guide curriculum development, we sought to determine what modifiable factors contribute to surgical residents successfully providing PC.

      Methods

      Eight focus groups with 34 participants were conducted. Semi-structured interviews were recorded, transcribed, and de-identified. Inductive thematic analysis was utilized to encode, identify, and categorize emergent themes.

      Results

      Barriers to resident involvement in PC included: Limited Knowledge/Inexperience, Communication Difficulties, Time Constraints, and Burnout. Factors supporting resident involvement included: Patient Relationship/Rapport, Expertise Guiding PC Discussions, and Institutional Support. Communication skills that support successful PC delivery include establishing rapport, managing conflicts, avoiding bias, and acknowledging personal/scientific limitations.

      Discussion

      This work identifies modifiable factors that support surgical residents providing PC. Faculty and institutional support, resident education on PC principles, and expanding clinical experience with PC may be the most modifiable from a programmatic perspective. Curriculum and process development focused on these areas will help optimize surgical resident's success delivering PC.

      Keywords

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