Perioperative Integration of Palliative Care and Urology for Patients With Serious Urologic Illness: A Qualitative Need Finding Inquiry.

Abstract

Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness. We conducted semi-structured interviews and team-based thematic analysis to consensus with a dual review. Purposefully sampled urologists, palliative care physicians, and clinical team members at fourteen geographically distributed Veteran Health Administration sites were interviewed. We identified one general overall theme, to "change culture" so that PC is not a "last resort," and three opportunities along the perioperative continuum for integrating urology and PC. Opportunity 1: Utilizing telehealth and team member role expansion when discussing the initial diagnosis, with surgery as a potential treatment option, allows for multiple conversations "so they're not rushed in 15 minutes to mentally deal with the new diagnosis." Opportunity 2: Creating a process to ensure goal of care conversations occur, since "urologic procedures can have complications that significantly impact quality of life," which "would require changing how our workflow is structured." Opportunity 3: During the preoperative visits, interdisciplinary input and evaluation of the patient prior to surgery allows the patient to "have a sort of joint meeting with us and the urologist." This represented the last point in time to de-escalate and offer nonsurgical options prior to surgery. The study informs future interventions to improve the quality of surgical care by integrating PC with urology in a unified workflow.