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To Face Coronavirus Disease 2019, Surgeons Must Embrace Palliative Care

Educational Objective
To understand how COVID-19 is increasing the importance of palliative care
1 Credit CME

As of mid-April 2020, there have been nearly 2 million confirmed cases of coronavirus disease 2019 (COVID-19), and more than 100 000 people have died.1 This historic pandemic has upended daily life globally and forced rationing in some of the world’s most high-income countries. To stem escalation of COVID-19, the World Health Organization has called for the deferral of elective surgery to divert personnel and equipment to patients with COVID-19. Thus, in the near term, surgical care is largely restricted to patients with the most severe illnesses and patients who are symptomatic and hospitalized (with any condition). Surgeons will also provide surgical and critical care for patients with COVID-19, a life-threatening virus that gives some affected individuals severe dyspnea or the need for a ventilator and thus isolates them from loved ones within days or weeks of onset. The experience in China and Italy warns other countries that the upcoming months will bring immeasurable pain to patients, families, and clinicians.

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Article Information

Corresponding Author: Zara Cooper, MD, MSc, Center for Surgery and Public Health, Brigham and Women’s Hospital, 1620 Tremont St, Ste 2-016, Boston, MA 02120 (zcooper@bwh.harvard.edu).

Published Online: April 28, 2020. doi:10.1001/jamasurg.2020.1698

Conflict of Interest Disclosures: None reported.

References
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Johns Hopkins University of Medicine. Johns Hopkins Coronavirus Resource Center. Accessed April 12, 2020. https://coronavirus.jhu.edu/
2.
National Coalition for Hospice and Palliative Care. Palliative care guidelines. Accessed March 24, 2020. https://www.nationalcoalitionhpc.org/ncp/.
3.
Lilley  EJ , Khan  KT , Johnston  FM ,  et al.  Palliative care interventions for surgical patients: a systematic review.   JAMA Surg. 2016;151(2):172-183. doi:10.1001/jamasurg.2015.3625PubMedGoogle ScholarCrossref
4.
American College of Surgeons Trauma Quality Improvement Program (TQIP). ACS TQIP palliative care best practices guidelines. Accessed March 24, 2020. https://www.facs.org/-/media/files/quality-programs/trauma/tqip/palliative_guidelines.ashx
5.
Olmsted  CL , Johnson  AM , Kaboli  P , Cullen  J , Vaughan-Sarrazin  MS .  Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration.   JAMA Surg. 2014;149(11):1169-1175. doi:10.1001/jamasurg.2014.2101PubMedGoogle ScholarCrossref
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Ariadne Labs. Serious illness care resources. Accessed March 21, 2020. https://www.ariadnelabs.org/areas-of-work/serious-illness-care/resources/#Downloads&%20Tools
7.
Campbell  TC , Schwarze  G , Zelenski  A , Johnson  S ; Palliative Care Quality Network. How to use the best case/worst case communication tool. Accessed March 20, 2020. https://www.pcqn.org/wp-content/uploads/2016/10/Navigating-Decision-Making_Best-Case-Worst-Case.pdf
8.
VitalTalk. COVID ready communication playbook. Accessed March 21, 2020. https://www.vitaltalk.org/guides/covid-19-communication-skills/
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American College of Surgeons. COVID-19 and surgery—resources for the surgical community. Accessed March 22, 2020. https://www.facs.org/about-acs/covid-19
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