Does regional variation impact decision-making in the management and palliation of pancreatic head adenocarcinoma? Results from an international survey

Valerie Hurdle, Jean Francois Ouellet, Elijah Dixon, Thomas J. Howard, Keith D. Lillemoe, Charles M. Vollmer, Francis R. Sutherland, Chad G. Ball

Research output: Contribution to journalArticle

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Abstract

Background: Management and palliation of pancreatic head adenocarcinoma is challenging. End-of-life decision-making is a variable process involving multiple factors. Methods:We conducted a qualitative, physician-based, 40-question international survey characterizing the impact of medical, religious, social, training and system factors on care. Results: A total of 258 international clinicians completed the survey. Respondents were typically fellowship-trained (78%), with a mean of 16 years' experience in a universityaffiliated (93%) hepato-pancreato-biliary group (96%) practice. Most (91%) believed resection is potentially curative. Most patients were discussed preoperatively by multidisciplinary teams (94%) and medical assessment clinics (68%), but rarely critical care (21%). Intraoperative surgical palliation included double bypass or no intervention for locally advanced nonresectable tumours (41% and 49% v. 14% and 85%, respectively, for patients with hepatic metastases). Postoperative admission to the intensive care unit was frequent (58%). Severe postoperative complications were often treated with aggressive cardiopulmonary resuscitation, intubation and critical care (96%), with no defined time points for futility (74%). Admitting surgeons guided most end-of-life decisions (97%). Formal medical futility laws were rarely available (26%). Insurance status did not alter treatment (97%) or palliation (95%) in non-universal care regions. Clinician ex - peri ence, regional culture and training background impacted treatment (all p < 0.05). Conclusion: Despite remarkable overall agreement, geographic and training differences are evident in the treatment and palliation of pancreatic head adenocarcinoma.

Original languageEnglish (US)
Pages (from-to)E69-E74
JournalCanadian Journal of Surgery
Volume57
Issue number3
DOIs
StatePublished - Jun 2014

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Medical Futility
Decision Making
Adenocarcinoma
Critical Care
Insurance Coverage
Cardiopulmonary Resuscitation
Intubation
Intensive Care Units
Therapeutics
Neoplasm Metastasis
Physicians
Liver
Surveys and Questionnaires
Neoplasms
Surgeons

ASJC Scopus subject areas

  • Surgery

Cite this

Does regional variation impact decision-making in the management and palliation of pancreatic head adenocarcinoma? Results from an international survey. / Hurdle, Valerie; Ouellet, Jean Francois; Dixon, Elijah; Howard, Thomas J.; Lillemoe, Keith D.; Vollmer, Charles M.; Sutherland, Francis R.; Ball, Chad G.

In: Canadian Journal of Surgery, Vol. 57, No. 3, 06.2014, p. E69-E74.

Research output: Contribution to journalArticle

Hurdle, Valerie ; Ouellet, Jean Francois ; Dixon, Elijah ; Howard, Thomas J. ; Lillemoe, Keith D. ; Vollmer, Charles M. ; Sutherland, Francis R. ; Ball, Chad G. / Does regional variation impact decision-making in the management and palliation of pancreatic head adenocarcinoma? Results from an international survey. In: Canadian Journal of Surgery. 2014 ; Vol. 57, No. 3. pp. E69-E74.
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