Abstract:
BACKGROUND:Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to evaluate their treatment choices in four different clinical scenarios. STUDY DESIGN:A 110-item survey was devised after extensive review of the palliative care and palliative surgery literature to evaluate current practices and attitudes regarding palliative surgery. Case vignettes were devised to evaluate dinical factors influencing surgeons' selection of treatment for symptomatic patients with advanced malignancy. RESULTS:Survey response rate was 24% (419 of 1,740). Respondents reported 74% of their surgery caseload as cancer related, and 21% of these as palliative. On a scale of 1 (uncommon problem) to 7 (common problem), surgeons reported that the most common ethical dilemmas in palliative surgery were providing patients with honest information without destroying hope (5.6 +/- 1.4) (mean +/- standard deviation), and preserving patient choice (5.0 +/- 1.7). Bound on error of the average frequency estimate for ethical dilemmas, based on response rate, was 0.08. On a scale of 1 (not a barrier) to 7 (a severe barrier), surgeons rated the most severe barriers to optimum use of palliative surgery as limitations of managed care (4.1 +/- 2.0) and referral to surgery by other specialists (3.9 +/- 1.8). Bound on error of the estimate for average severity of barriers, based on response rate, was 0.09. They rated the least severe barriers to palliative surgery as surgeon avoidance of dying patients (3.0 +/- 1.8) and surgery department reluctance to perform palliative surgery (2.6 +/- 1.6). Analysis of surgeons' treatment selection in case vignettes indicated that patient age, aggressiveness of tumor biology, local extent of disease, and severity of patient symptoms were all variables of influence for treatment selection in patients with advanced malignancies. CONCLUSIONS:Palliative surgery involves numerous ethical dilemmas, the most prominent being providing honest information to patients without destroying hope, and complex treatment decision making. We have identified variables of major influence to surgeons in the palliative treatment selection for patients with advanced, solid malignancies. Validation of these variables as meaningful will require future studies focusing on patient outcomes.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
McCahill LE,Krouse RS,Chu DZ,Juarez G,Uman GC,Ferrell BR,Wagman LDdoi
10.1016/s1072-7515(02)01306-6keywords:
subject
Has Abstractpub_date
2002-09-01 00:00:00pages
411-22; discussion 422-3issue
3eissn
1072-7515issn
1879-1190pii
S1072-7515(02)01306-6journal_volume
195pub_type
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journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Academic divisions of general surgery are facing ever-increasing financial pressures. Cost-cutting is a common approach to maintaining profitability, but strategies to increase revenue should not be ignored. One specific avenue for enhanced revenue generation in general surgery is that of coding for evaluati...
journal_title:Journal of the American College of Surgeons
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doi:10.1016/j.jamcollsurg.2004.03.002
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. STUDY DESIGN:Patients sched...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2010-06-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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doi:10.1016/j.jamcollsurg.2004.03.025
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abstract:BACKGROUND:The mortality rate of bleeding esophageal varices in cirrhosis is highest during the period of acute bleeding. This is a report of a randomized trial that compared endoscopic sclerotherapy (EST) with emergency portacaval shunt (EPCS) in cirrhotic patients with acute variceal hemorrhage. STUDY DESIGN:A total...
journal_title:Journal of the American College of Surgeons
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更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Hepatic resection and percutaneous transhepatic cholangioscopic lithotomy (PTCSL) are the two main approaches to the treatment of hepatolithiasis, but comparisons of longterm followup results have not been adequately reported. STUDY DESIGN:Of 86 patients with hepatolithiasis admitted to our institution betw...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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journal_title:Journal of the American College of Surgeons
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doi:10.1016/j.jamcollsurg.2008.09.006
更新日期:2009-01-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.11.014
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:E75 is an immunogenic peptide from the HER2/neu protein that is expressed in prostate cancer. High-risk prostate cancer (HRPC) patients demonstrating varying levels of HER2/neu expression were vaccinated with E75 peptide plus granulocyte-macrophage colony-stimulating factor to prevent postprostatectomy PSA a...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.10.018
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:Infants have the highest wait-list mortality of all liver transplantation candidates. Deceased-donor split-liver transplantation, a technique that provides both an adult and pediatric graft, might be the best way to decrease this disproportionate mortality. Yet concern for an increased risk to adult split re...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.06.005
更新日期:2013-10-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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更新日期:2017-11-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1072-7515(02)01219-x
更新日期:2002-08-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.07.029
更新日期:2008-02-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.03.015
更新日期:2012-08-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
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更新日期:2019-04-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:
更新日期:1997-10-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.01.060
更新日期:2013-06-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-07-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.04.026
更新日期:2006-08-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
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更新日期:2017-09-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00417-4
更新日期:2003-09-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.08.005
更新日期:2008-02-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.12.001
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Autologous transfusion (AT) has long been considered unsafe in major oncologic operations due to a theoretic risk of spreading metastatic disease, however, few data support this assumption. STUDY DESIGN:We conducted a retrospective analysis of 147 patients who underwent partial hepatectomy for colorectal ca...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.10.020
更新日期:2019-06-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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更新日期:2015-05-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
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更新日期:2021-02-01 00:00:00