Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Subject Areas | Description |
---|---|
Age | 64 years |
Current medical history | First diagnosis of a rectum carcinoma six months ago. At the time of diagnosis, already metastasized disease with liver and lung metastasis. Initiation of palliative chemotherapy to inhibit tumor growth. After initially well-controlled symptoms, rapid clinical detoriation and increasing symptom load over the last two weeks with increasing pain levels and levels of nausea/vomiting and fatigue. After initial treatment of these symptoms and, again, improved symptom control, development of a high obstructive ileus. Subsequently, the patient is scheduled for surgical treatment with a palliative gastrostoma. |
Previous illnesses | None |
Social background | Married for 40 years, no children |
Family medical history | Father died from hepatic cellular carcinoma, mother died from breast carcinoma. Both parents had been cared for by the patient until their deaths. Both parents had suffered for a long time due to their illnesses. Based on that experience, the patient has set up an advanced directive. |
Character | Patient is calm and composed. Has come to terms with the disease. Is glad that the pain is well adjusted. Knows about the limited life expectancy. Hopes to obtain symptom relief from nausea and vomiting through the planned surgery. |
Document Type | Summarized Content |
---|---|
Discharge letter from previous hospital | List of previous diagnoses including the presence of a pectoral port catheter. Outline of the previous medical history and treatment. Different examinations with no abnormal findings on ECG, echocardiography, or chest x-ray. CT-scan of the abdomen noticeable for tumor mass leading to obstruction of the small intestine and ileus, additional lesions in the lumbar spine, highly suspicious of bone metastasis. |
Lab results | Noticeable for increased creatinine levels (1.3 mg/dL) and reduced hemoglobin levels (10.9 g/dL) |
Patient chart | Current vital signs, current medication (Fentanyl transdermal patch 250 µg/h, Ibuprofen 800mg TID, Metoclopramide 10 mg TID, Macrogol TID, Pantoprazole 40 mg QD) |
Informed Consent Form | This questionnaire, pre-filled by the patient, provides information, among other things, about previous illnesses and medication. The last question is: “Do you have an advanced directive?” This is answered with a yes. The form is also used for the documentation of the written informed consent. |
Advanced Directive | The advance directive was not part of the documents automatically given to the anesthesiologist, but it was provided by the patient only upon request from the anesthesiologist. The form used for this advance directive is the official template for advance directives published by the German Federal Justice Department. The patient expressly rejects intensive therapy and treatment of cardiac arrest by chest compression and defibrillation under all circumstances. Mechanical ventilation and medical support of circulation are allowed only for the time of anesthesia/surgery. The reason for this rejection is mentioned in the advance directive (parents’ suffering). |
Group 1 (N = 16) | Group 2 (N = 16) | Total (N = 32) | |
---|---|---|---|
Port Catheter | |||
Port catheter mentioned spontaneously | 15 (94%) | 16 (100%) | 31 (97%) |
Port catheter can be used for induction | |||
| 2 (13%) | 3 (19%) | 5 (16%) |
| 6 (38%) | 11 (69%) | 17 (53%) |
| 0 (0%) | 2 (13%) | 2 (6%) |
| 8 (50%) | 0 (0%) | 8 (25%) |
Port catheter’s use documented on anesthesia chart | 0 | 1 (6%) | 1 (3%) |
Preoperative Nausea and Vomiting | |||
Nausea/vomiting mentioned spontaneously | 16 (100%) | 16 (100%) | 32 (100%) |
RSI mentioned spontaeneously | 10 (63%) | 13 (81%) | 23 (72%) |
RSI mentioned after direct question 2 | N/A | 2 (13%) | 2 (6%) |
Therapy for nausea/vomiting discussed 3 | |||
| 2 (13%) | 1 (6%) | 3 (9%) |
| 3 (19%) | 2 (13%) | 5 (16%) |
| 11 (69%) | 13 (81%) | 24 (75%) |
Therapy for nausea/vomiting documented on anesthesia chart | 4 (25%) | 3 (19%) | 7 (22%) |
Transdermal Fentanyl Patch | |||
Fentanyl patch mentioned spontaneously | 15 (94%) | 15 (94%) | 30 (94%) |
Fentanyl patch mentioned after direct question 2 | N/A | 1 (6%) | 1 (3) |
Handling of the fentanyl patch | |||
| 5 (31%) | 16 (100%) | 21 (66%) |
| 0 (0%) | 0 (0%) | 0 (0%) |
| 11(69%) | 0 (0%) | 11 (34%) |
Additional pain therapy discussed | |||
| 4 (25%) | 3 (19%) | 7 (22%) |
| 0 (0%) | 1 (6%) | 1 (3%) |
| 12 (75%) | 12 (75%) | 24 (75%) |
Handling of the fentanyl patch documented on anesthesia chart | 8 (50%) | 11 (69%) | 19 (59%) |
Advance Directive (AD) with DNR-Order | |||
AD mentioned spontaneously | 4 (25%) | 0 (0%) | 4 (13%) |
AD mentioned only after direct question 2 | N/A | 16 (100%) | 16 (50%) |
Intraoperative handling of the DNR order | |||
| 3 (19%) | 13 (81%) | 16 (50%) |
| 1 (6%) | 3 (19%) | 4 (13%) |
| 12 (75%) | 0 (0%) | 12 (38%) |
AD’s existence documented on anesthesia chart | 4 (25%) | 16 (100%) | 20 (63%) |
AD’s handling documented on anesthesia chart | 2 (13%) | 12 (75%) | 14 (44%) |
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© 2024 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Lassen, C.L.; Jaschinsky, F.; Stamouli, E.; Lindenberg, N.; Wiese, C.H.R. Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients. Medicina 2024, 60, 1577. https://doi.org/10.3390/medicina60101577
Lassen CL, Jaschinsky F, Stamouli E, Lindenberg N, Wiese CHR. Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients. Medicina. 2024; 60(10):1577. https://doi.org/10.3390/medicina60101577
Chicago/Turabian StyleLassen, Christoph L., Fabian Jaschinsky, Elena Stamouli, Nicole Lindenberg, and Christoph H. R. Wiese. 2024. "Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients" Medicina 60, no. 10: 1577. https://doi.org/10.3390/medicina60101577