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End of Life

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

JAMA Surgery

Published Online: April 28, 2020

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Article Information and Disclosures

Zara Cooper, MD, MSc¹;

Rachelle E. Bernacki, MD, MS²

Author Affiliations

¹Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
²Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts

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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

Johns Hopkins University of Medicine. Johns Hopkins Coronavirus Resource Center. Accessed April 12, 2020. https://coronavirus.jhu.edu/

National Coalition for Hospice and Palliative Care. Palliative care guidelines. Accessed March 24, 2020. https://www.nationalcoalitionhpc.org/ncp/.

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.2015.3625 PubMed Google Scholar Crossref

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

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.2014.2101 PubMed Google Scholar Crossref

Ariadne Labs. Serious illness care resources. Accessed March 21, 2020. https://www.ariadnelabs.org/areas-of-work/serious-illness-care/resources/#Downloads&%20Tools

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

VitalTalk. COVID ready communication playbook. Accessed March 21, 2020. https://www.vitaltalk.org/guides/covid-19-communication-skills/

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

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.