1. Does regional variation impact decision-making in the management and palliation of pancreatic head adenocarcinoma? Results from an international survey.
- Author
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Hurdle V, Ouellet JF, Dixon E, Howard TJ, Lillemoe KD, Vollmer CM, Sutherland FR, and Ball CG
- Subjects
- Africa, Canada, Cultural Characteristics, Europe, Health Care Surveys, Humans, Medical Futility legislation & jurisprudence, Pancreaticoduodenectomy, Postoperative Care methods, Practice Guidelines as Topic, Preoperative Care methods, Qualitative Research, Religion and Medicine, United States, Adenocarcinoma therapy, Attitude of Health Personnel, Decision Making, Palliative Care, Pancreatic Neoplasms therapy, Practice Patterns, Physicians' statistics & numerical data, Terminal Care
- Abstract
Background: Management and palliation of pancreatic head adenocarcinoma is challenging. End-of-life decision-making is a variable process involving multiple factors., Methods: We conducted a qualitative, physician-based, 40-question international survey characterizing the impact of medical, religious, social, training and system factors on care., Results: A total of 258 international clinicians completed the survey. Respondents were typically fellowship-trained (78%), with a mean of 16 years' experience in a university-affiliated (93%) hepato-pancreato-biliary group (96%) practice. Most (91%) believed resection is potentially curative. Most patients were discussed preoperatively by multidisciplinary teams (94%) and medical assessment clinics (68%), but rarely critical care (21%). Intraoperative surgical palliation included double bypass or no intervention for locally advanced nonresectable tumours (41% and 49% v. 14% and 85%, respectively, for patients with hepatic metastases). Postoperative admission to the intensive care unit was frequent (58%). Severe postoperative complications were often treated with aggressive cardiopulmonary resuscitation, intubation and critical care (96%), with no defined time points for futility (74%). Admitting surgeons guided most end-of-life decisions (97%). Formal medical futility laws were rarely available (26%). Insurance status did not alter treatment (97%) or palliation (95%) in non-universal care regions. Clinician experience, regional culture and training background impacted treatment (all p < 0.05)., Conclusion: Despite remarkable overall agreement, geographic and training differences are evident in the treatment and palliation of pancreatic head adenocarcinoma.
- Published
- 2014
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