Seriously Ill and Older Adults
CPSH researchers are working to improve surgical outcomes for patients that are not well-served by existing healthcare practices, including older and seriously ill patients, patients with dementia, and sex and gender minorities. They are studying how to improve interactions between patients, their caregivers, and health professionals, and implementing new pathways of care that respect patient choice and are better adapted to patient needs.
The SHARPP Program conducts patient-centered research focused on surgical patients with serious illnesses facing complex surgical procedures. The program’s vision is to create an internationally renowned group of clinician-scientists and health services researchers who conduct patient-centered research in all phases of surgical care. The program aims to accomplish this through unparalleled leadership in the following ways: making significant contributions to the scientific evidence base, developing and implementing novel programs, and by engaging key stakeholders in surgical care to influence health policy.
Advance care planning, or ACP, conversations are discussions that occur between patients, caregivers, and clinicians about preferences for future medical care in the case health declines. These conversations include discussing what patients value, their hopes, goals and concerns about the future that could influence the type of medical care they want or don’t want. Funded by a grant from the National Institutes of Health, the Medicare ACP Uptake study used both quantitative and qualitative methods to provide a unique scientific examination of the use of ACP discussions and their impact on the intensity and outcomes of care received by patients nearing the end of life, including patients with Alzheimer’s Disease and Related Dementias (ADRD) and sexual and gender minorities.
- Alzheimer’s Disease and Related Dementia (ADRD)
- Sexual and Gender Minorities (SGM)
Surgery often has benefits, such as reducing symptoms or extending life, but it is not without risk. Patients vary both in their tolerance of symptoms and of surgical risk. Surgical decision-making for persons living with dementia (PLWDs) is challenging for numerous reasons, including limited longitudinal data on outcomes, an inability of the patient to fully participate in the discussion, and vague advance directives with multiple caregivers. Funded by the NIH, the Decisions Around Dementia and Surgery (DecADES) study is designed to address the lack of evidence-based guidelines on surgical decision-making for PLWDs.
Over 1 million older adults with serious illness have major surgery or severe trauma each year, after which they are at high risk for healthcare use, functional and cognitive decline, and mortality. While palliative care for such patients is associated with reduced symptoms and less healthcare utilization after discharge, surgical patients are less likely to than other patients to receive it. Funded by the NIH, the Layered Examination of Adult Palliative care in Surgery (LEAPS) study will provide an examination of palliative care for older surgical patients.