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Die Trying Pdf

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Although surgeons agreed that very frail patients should not have surgery they held conflicting views about how to present treatment options; some surgeons would not offer surgery, others would heavily favor palliative care and some would state the options and let the patient or family decide.

Surgeons noted several factors beyond their control that contribute to a clinical momentum promoting surgical intervention despite professional concerns that surgery is not valuable. These findings are important because they suggest that misunderstandings and faulty expectations determine the outcome of high-stakes surgical decision making.

Observation of these challenges to surgical decision making presents an opportunity to assist frail elderly patients and their families in the setting of acute surgical illness and has important implications for surgeons, patients and policy makers. For surgeons, it is critical to appreciate and dispel false assumptions about treatment outcomes for frail elderly patients.

As intra operative death is a rare occurrence, surgeons need to illustrate the cascade of postoperative complications and interventions that typically precede postoperative death rather than simply stating the statistical probability of death. Surgeons will also need to describe the range of surgical outcomes for the individual patient within the context of the patient's overall prognosis with careful attention to the patient's health trajectory before surgical illness.

Given patient skepticism and popular notions about the capacity of modern medicine 18 this may require support from surgical colleagues or the patient's primary care physician. Furthermore, such efforts may prevent surgeon frustration, dismay and emotional accountability stemming from downstream withdrawal of postoperative life supporting treatments.

Because physicians in general discuss treatments and fail to offer information about long-term prognosis 22 - 24 patients and their families are woefully unprepared for an acute event and struggle to place a decision about surgery within the larger context of their overall health.

Instead they use heuristics to choose surgery 25 and may not incorporate their previously stated preferences and values about quality of life. These overly simplified decisions may lead to unwanted invasive treatments at the end of life.

We are hopeful that some seniors were able to do the harder work of imagining their reaction to future health states and could see that the best outcome of surgery was a state where quality of life was not acceptable.

Future efforts to improve decision making will need to focus on helping patients move from intuitive-emotional decision making and embrace effortful and more analytic decision making. Hospital processes that increase efficiency may benefit patients through provision of earlier treatment, reduced length of stay and decreased hospital costs.

However, these same efficiencies inhibit opportunity for deliberation between doctors and patients about whether intervention is even appropriate. This is further compounded by messages inferred from physicians requesting surgical consultation and family expectations to produce a powerful force of clinical momentum that favors intervention and is difficult to reverse with a simple conversation between surgeon and patient. Our study highlights an ethical tension for surgeons about how to discuss possible treatments for patients who are unlikely to survive postoperatively.

When surgeons present surgery as a possible option, patients and their families may view surgery as beneficial even though the surgeon thinks differently.

In addition, our data highlight that seniors prefer to make difficult decisions in conjunction with their physician rather than choose from a menu of treatment options. As such, a better strategy would focus the discussion on prognosis and goals as opposed to treatments and choices and culminate with a strong recommendation from the surgeon. For surgeons, it is critical to appreciate and dispel false assumptions about treatment outcomes for frail elderly patients.

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As intra operative death is a rare occurrence, surgeons need to illustrate the cascade of postoperative complications and interventions that typically precede postoperative death rather than simply stating the statistical probability of death.

Surgeons will also need to describe the range of surgical outcomes for the individual patient within the context of the patient's overall prognosis with careful attention to the patient's health trajectory before surgical illness. Given patient skepticism and popular notions about the capacity of modern medicine 18 this may require support from surgical colleagues or the patient's primary care physician.

Furthermore, such efforts may prevent surgeon frustration, dismay and emotional accountability stemming from downstream withdrawal of postoperative life supporting treatments. Because physicians in general discuss treatments and fail to offer information about long-term prognosis 22 - 24 patients and their families are woefully unprepared for an acute event and struggle to place a decision about surgery within the larger context of their overall health.

Constructing High-Stakes Surgical Decisions: It's Better to Die Trying

Instead they use heuristics to choose surgery 25 and may not incorporate their previously stated preferences and values about quality of life. These overly simplified decisions may lead to unwanted invasive treatments at the end of life. We are hopeful that some seniors were able to do the harder work of imagining their reaction to future health states and could see that the best outcome of surgery was a state where quality of life was not acceptable.

Future efforts to improve decision making will need to focus on helping patients move from intuitive-emotional decision making and embrace effortful and more analytic decision making.

Hospital processes that increase efficiency may benefit patients through provision of earlier treatment, reduced length of stay and decreased hospital costs. However, these same efficiencies inhibit opportunity for deliberation between doctors and patients about whether intervention is even appropriate.

This is further compounded by messages inferred from physicians requesting surgical consultation and family expectations to produce a powerful force of clinical momentum that favors intervention and is difficult to reverse with a simple conversation between surgeon and patient. Our study highlights an ethical tension for surgeons about how to discuss possible treatments for patients who are unlikely to survive postoperatively.

When surgeons present surgery as a possible option, patients and their families may view surgery as beneficial even though the surgeon thinks differently.

The List: the 34,361 men, women and children who perished trying to reach Europe

In addition, our data highlight that seniors prefer to make difficult decisions in conjunction with their physician rather than choose from a menu of treatment options.

As such, a better strategy would focus the discussion on prognosis and goals as opposed to treatments and choices and culminate with a strong recommendation from the surgeon.

While many acute surgical illnesses do not predictably lead to grim outcomes like those described in our focus group, it is important to recognize and avoid the unnecessary damage incurred by presenting patients and families with a choice when the benefits of surgery are so limited. The focus group script was designed to elicit feedback regarding a communication tool, thus there were no prompts or mechanism to explore the themes described herein more fully.

While we purposefully selected seniors who had experience making difficult medical decisions, all participants were community dwelling and presumably had some distance from the prospect of acute illness. Consistent with prospect theory, less healthy participants may have expressed stronger preferences for life sustaining interventions 28 or have a broader definitions about acceptable quality of life.

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