title: Sudden Advanced Illness: An Emerging Concept Among Palliative Care and Surgical Critical Care Physicians.
abstract: BACKGROUND
  End-of-life discussions in critically-ill patients with acute surgical conditions may be rushed and occur earlier during hospitalization. This study explores the concept of sudden advanced illness (SAI) and its relevance to patients requiring Palliative and Surgical Critical Care.
  
  
  METHODS
  Semi-structured interviews were completed with 16 physicians, querying each about (1) definitional components, (2) illustrative cases, and (3) comfort with SAI. Analysis was done by grounded theory.
  
  
  RESULTS
  SAI was characterized as unforeseen, emerging abruptly and producing devastating injury, often in healthy, younger patients. There is (1) prognostic uncertainty, (2) loss of capacity, and (3) unprepared surrogate decision-making. Cases are emotionally-charged and often personal.
  
  
  CONCLUSIONS
  The emerging concept of SAI is important for understanding how Palliative Care can enhance care for this subset of patients.
authors.affiliation: Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham-Birmingham, AL, USA Division of General Pediatrics and Adolescent Medicine, University of Alabama at Birmingham-Birmingham, AL, USA mbarnett@peds.uab.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Barnett
authors.affiliation: Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham-Birmingham, AL, USA Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham VA Medical Center-Birmingham, AL, USA.
authors.forename: Beverly R
authors.initials: BR
authors.lastname: Williams
authors.affiliation: Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham-Birmingham, AL, USA.
authors.forename: Rodney O
authors.initials: RO
authors.lastname: Tucker
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D003657:Decision Making; D018450:Disease Progression; D004644:Emotions; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007407:Interviews as Topic; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology; D010358:Patient Participation; D010820:Physicians; D011379:Prognosis; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology; D035501:Uncertainty
keywords: caregiver issues; critical care; decision making; palliative care; prognostication; surgery