Dr. Shoher has a strong interest in health policy and surgical outcomes in elderly, surgical patients. This grant will allow her to obtain a Doctorate of Public Health at the Johns Hopkins Bloomberg School of Public Health in advanced public health methodology. The goal of this proposal is to evaluate how improved communication and consensus building regarding the expectation of survival and quality of life between medical care providers and family members of elderly, surgical patients affects the decision to withdraw or limit futile, end of life care. This goal is in direct alignment with the National Institute of Aging, which supports programs of research on all aspects of aging, including the social aspects of growing older and the economic implications of an aging society. The primary hypothesis of this study is that improved communication about the prognosis of elderly (>65 years old), surgical patients with prolonged ICU stays (>5 days) will decrease futile, end of life care. For this study futility will be defined as prolonged care in patients who have less than a 1% chance of surviving 30 days. The first outcome of interest will be to develop and validate expected survival and quality of life scoring models for elderly surgical patients with prolonged (>5 days) ICU stays. The second outcome, to be gathered by survey data, will be to ascertain from medical providers and patient family members their expectation of survival and post-operative quality of life for elderly surgical patients. The nominal group technique will be used to reach a consensus on subjective measurements of survival and quality of life between the medical team and family members of the patient population. The third outcome as a result of this intervention will be to determine if consensus building and improved communication via weekly family meetings decrease futile, end of life care in elderly surgical patients Improved identification of patients who do not have an acceptable survival risk or expected quality of life, as determined by the patient and his/her family, may decrease futile, end of life care in surgical patients. Improved communication about a patient's prognosis between the medical staff and the family members of elderly, critically ill patients may also decrease futile care and improve overall satisfaction with end of life care. For the society at large decreasing futile, end of life care can help reduce the increasing medical cost and emotional distress associated with end of life care in our aging population.
