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Patient Safety and Quality Improvement

What Really Matters: End-of-Life Care in Otolaryngology

Wednesday, October 4, 2023
10:30 AM - 11:30 AM East Coast USA Time
Location: 202A

    Moderator(s)

  • AR

    Andrew J. Redmann, MD

    Assistant Professor
    University of Minnesota-Department of Otolaryngology Head and Neck Surgery
    Shoreview, MN, United States

    • Panelist(s)

  • Andrew G. Shuman, MD

    Associate Professor
    University of Michigan Health System
    Ann Arbor, MI, United States

  • SM

    Susan McCammon, MD

    Associate Professor
    Department of Otolaryngology- Head and Neck Surgery, University of Texas Medical Branch
    Galveston, Texas, United States

  • JS

    Jayne R. Stevens, MD

    Brooke Army Medical Center, USA

Disclosure(s):
Andrew J. Redmann, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Otolaryngologists often care for patients at the end of their life, but are rarely comfortable with switching from curative treatment to a palliative treatment paradigm. In addition, otolaryngologists are often uncomfortable treating common conditions that arise in this patient population, including chronic pain, and depression/anxiety. Discussions surrounding end of life issues often arise in residency, but current residency education models provide little formal education on how to approach patients at the end of life. Recent evidence suggest that only about 5% of terminal Otolaryngology patients receive palliative care consultation, indicating an opportunity for quality improvement in this setting. This session will describe the most current research on end of life care, and discuss how the principles of palliative care can be applied to patients to improve the quality of care Otolaryngologists provide. Foundational ethical principles of autonomy, beneficence, non-maleficence and justice will be described so that surgeons have tools to approach difficult patient encounters. A case based approach will be used to illustrate how Otolaryngologists experienced with treating terminal patients approach patient care in this situation. Cases will be used as a springboard to discuss important considerations for otolaryngology patients at the end of life, such as disfigurement, communication difficulties and dysphagia in head and neck cancer and issues of substituted judgement in pediatric patients. The COVID-19 pandemic will also be addressed, especially situations where Otolaryngologists are asked to perform tracheostomy in COVID-19 positive patients. Finally, a framework on how to approach terminal patients will be shared as a practical take-away for improving care at the bedside.

OUTCOME OBJECTIVE 1: 1) Understand the principles of medical ethics as they relate to terminal Otolaryngology patients

OUTCOME OBJECTIVE 2: 2) Recognize the unique challenges in Otolaryngology patients at the end of life

OUTCOME OBJECTIVE 3: 3) Explain the role of palliative care in the treatment of Otolaryngology patients at the end of life

BACKGROUND STATEMENT: Recent data suggests that there is a need for physicians (including Otolaryngologists) to better understand non-curative treatment options for patients with terminal illnesses. Caring for these difficult patients often occurs in residency despite no formal training in this area.