The following is a summary of “Recognizing the Need for Goals of Care Conversations Among Critically Ill Surgical Patients,” published in the February 2025 issue of Critical Care by Meredyth et al. 

The need for end-of-life care is critical yet often unrecognized in patients having surgery, leading to suffering and unnecessary healthcare costs despite comorbidities and differing patient/family wishes.  

Researchers conducted a retrospective study to explore whether patients having surgery with clear end-of-life needs received goals of care (GoC) conversations, with variations in frequency by provider level and specialty.  

They assessed 5 case vignettes of patients with critically illness undergoing surgery at an urban, academic, quaternary care center. Blinded providers were asked to identify at least 3 care priorities for each patient. Responses were analyzed using Stata/BE 17.0 to determine the inclusion of GoC.  

The results showed 123 participants responded to at least 1 scenario (24.1% response rate), of these, 95 participants (77.2%) prioritized GoC at least once, with GoC prioritization ranging from 9.7% (scenario 1) to 73.7% (scenario 5). Surgical providers prioritized GoC more frequently than nonsurgical providers (83.1% vs 67.4%, P = 0.044). Critical care specialty training did not significantly impact GoC prioritization (83.3% vs 71.4%, P = 0.12). Elevated post-graduate year (PGY) levels correlated with increased GoC prioritization; 60.9% of PGY1-4 prioritized GoC compared to 90.9% of PGY5-9 (P = 0.007).  

Investigators concluded that higher PGY levels and familiarity with surgical pathologies were associated with increased prioritization of GoC by providers. 

Source: sciencedirect.com/science/article/abs/pii/S0022480424008308