Many surgeons do not discuss advance directives with their patients before surgery
Surgeons try to do everything to achieve successful
outcomes after surgery. Yet, some operations remain
high-risk for patient mortality and require life-sustaining
care afterwards. Given this thinking, some
surgeons may be reticent to discuss advance directives
with patients prior to surgery. In fact, a new study finds
that such discussions are not routine among surgeons.
What's more, some surgeons are not willing to operate
on a patient if advance directives will limit
Researchers sent a survey to 2,100 surgeons selected at
random. Their subspecialties were vascular surgery,
neurosurgery, and cardiothoracic surgery. All were
likely to perform high-risk operations on patients with
numerous coexisting conditions. The survey asked the
surgeons about their beliefs in advance directives, how
they communicate with patients about them, and the
limitations of life-supporting care. A total of 912
questionnaires were completed.
Nearly all of the surgeons said they discussed with
patients the possibility of unanticipated outcomes and
need for postoperative life-supporting therapy prior to
surgery. However, about half (52 percent) of surgeons
discussed advance directives before surgery. In
addition, 54 percent admitted that they would not
operate on a patient if the advance directives interfered
or limited life-supporting therapy. Cardiothoracic surgeons were more likely to decline to
operate compared to the other specialists. The
researchers suggest that patient preferences be clarified
prior to surgery, since advance directives are not
specifically designed for high-risk procedures. The
study was supported in part by the Agency for
Healthcare Research and Quality (HS189960).
See "Use of advance directives for high-risk operations:
A national survey of surgeons," by Andrew J.
Redmann, B.A., B.S., Karen J. Brasel, M.D., M.P.H.,
Caleb G. Alexander, M.D., M.S., and Margaret L.
Schwarze, M.D., M.P.H., in the March 2012 Annals of
Surgery 255(3), pp. 418-423.
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