Susan Mccammon

[Susan Mccammon @sdmccammon]

https://t.co/XfrF037FAS

[Susan Mccammon @sdmccammon]

@RedMDND Love it!

[Surgical Palliative Care Society @SPCSociety]

Surgical Palliative Care: Considerations for Career Development in Surgery and Hospice and Palliative Medicine https://t.co/nBTbtuDusP

[Susan Mccammon @sdmccammon]

@JournalofEthics @DrSabha @ScottSchweikart Thank you!

[Susan Mccammon @sdmccammon]

@JournalofEthics Some reseach has shown that patients may make decisions about procedures based on the quality of the doctor patient relationship rather than any statistical survival data. #LouiseDavies

[Susan Mccammon @sdmccammon]

@JournalofEthics Because the patient may be under general anesthesia during the operation, surgeons and patients often have to talk about contingencies and intraoperative decision making. Not every finding can be anticipated preoperatively, so trust is essential.

[Susan Mccammon @sdmccammon]

@JournalofEthics The AMA also acknowledges that palliative care is useful in chronic illnesses with high symptom burden, even if patients are not at the end of life.

[Susan Mccammon @sdmccammon]

@JournalofEthics Also, the AMA HOD emphasizes the importance of training in generalist palliative care for all medical providers and this helps lead to policies that can fund that training.

[Susan Mccammon @sdmccammon]

@JournalofEthics Again, the right of every patient to be cared for in a way that acknowledges and addresses suffering.

[Susan Mccammon @sdmccammon]

@DrSabha @JournalofEthics Absolutely--Dr. Ganai--we need to aim our research and clinical work at achieving goals that are important to patients.

[Susan Mccammon @sdmccammon]

@JournalofEthics Justice is extremely important. Right now, there are many people who do not have access to high quality palliative care. Or the care they can access does not know how to communicate effectively in different cultures. #RonitElk

[Susan Mccammon @sdmccammon]

@JournalofEthics Ensuring diversity in the palliative care workforce is essential.

[Susan Mccammon @sdmccammon]

@JournalofEthics Good palliative care takes time and the pace of modern western biomedicine allows very little margin for time investment. Training and practice and self awareness are important, but often time is the rate limiting factor.

[Susan Mccammon @sdmccammon]

@JournalofEthics It is important to communicate clearly that the data we have for survival outcomes for high risk operations are often limited. Those statistics are often not that helpful for patients to imagine possible outcomes.

[Susan Mccammon @sdmccammon]

@JournalofEthics Scenario planning, like the Best case-worst case decision tool developed by Dr. Schwarze's lab in WI.

[Susan Mccammon @sdmccammon]

@JournalofEthics The success of a palliative intervention has to be determined by the patient's goals--relief of pain, ability to go home, fewer days in hospital, management of a difficult wound....

[Susan Mccammon @sdmccammon]

@JournalofEthics In terms of ethical principlism, I think beneficence and nonmaleficence are predominant. Calculating and minimizing acceptable harms.

[Susan Mccammon @sdmccammon]

@ScottSchweikart @JournalofEthics Most curative intent operations are palliative to some degree--they relieve symptoms. But some are not--my father had an open repair of an asymptomatic AAA and that was to prevent future suffering.

[Susan Mccammon @sdmccammon]

@JournalofEthics Beyond the intended outcome (cure or relief), the term "curative intent" also includes the level of risk or comorbidity we are willing to accept from a treatment.

[Susan Mccammon @sdmccammon]

@JournalofEthics Absolutely Dr. Ganai--this is why it is so important to have surgeons who are trained in discussing palliative goals of care.