title: A values-based conceptual framework for surgical appropriateness: an illustrative case report.
abstract: Appropriateness in surgical decision-making necessitates that surgical treatments are aligned with patients' goals and values for care. To arrive at informed decisions for surgery, patients must have an understanding of post-operative recovery, the impact on quality of life, and expected functional outcomes. This article describes an illustrative case of an older patient who experienced a decline in health, functional status, and quality of life in the months following a major surgical operation that was not clearly aligned with her personal goals and priorities. Palliative care needs that arose during the course of the patient's treatment are identified and described, revealing opportunities for better integration between palliative and postoperative care. A conceptual framework for measuring appropriateness in surgery, which incorporates patients' goals, values and preferences for medical treatments, is proposed.
authors.affiliation: The Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Lilley
authors.affiliation: The Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Bader
authors.affiliation: The Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA. zcooper@partners.org.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
mesh_terms: D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D010146:Pain / Q000209:etiology / Q000523:psychology*; D010166:Palliative Care / Q000379:methods / Q000523:psychology / Q000592:standards*; D057240:Patient Preference; D011369:Professional-Patient Relations; D011788:Quality of Life; D019452:Terminally Ill / Q000523:psychology*; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy
keywords: Decision-making; palliative care; supportive oncology; surgical patients; terminal care