P036: PATIENT CENTERED CARE: A CASE REPORT OF SHARED DECISION MAKING IN THE MIDST OF A DIFFICULT AIRWAY
Uche Ike, MD; Nelson N Algarra, MS, MD; Taylor Johnson, MD; University of Florida
Introduction: Patient centered care elicit patients’ perspective of their illness and addresses their concerns. Our goal is to provide safe, quality care that ensures respect for patient values and preferences. (1). The application of patient centered care encompasses shared decision making which supports the patient with a better understanding and responsibility in making decisions about their care.
Case: A 64 yr. old female with history of non-small cell lung cancer with muco-cutaneous metastasis was initially treated with left neck dissection and chemo-radio therapy in 2010. Her course was complicated by multiple cancer recurrences with repeat treatment which led to the development of severe facial, neck and upper extremity lymphedema in 2016. She underwent lymph node transfer surgery with ALT flap in 2018 with marginal success. Her lymphedema worsened as evidenced by CT neck attained in 2019. She had limited mouth opening, large tongue, oropharynx & pharyngeal edema and limited neck extension. The patient’s lymphedema was so severe effecting her quality of life that she elected for a surgical intervention.
Discussion: A recent study demonstrates that patients felt more satisfied and respected by participating in the decision making process for selecting anesthesia methods for surgery either via active or collaborative role (2). She was seen in the presurgical clinic where we elicited her concerns and provided support to facilitate her contributing towards her anesthetic plan. While operating within ASA practice guidelines for management of difficult airway and with full understanding of her disease process and her values and preference, a shared decision was made to perform an awake fiber optic nasal intubation with other anesthesia considerations. She had cutaneous metastasis around her neck and a surgical airway was deemed impossible. She emphasized comfort and companionship so the perioperative physician and family/friend support was integral. She preferred continuity of care, hence we coordinated and integrated anesthesia management even after her transition to the ICU which led to a successful extubation. She understood the possibility of death but did not want to be ventilator dependent. This guided intraoperative anesthetic management to optimize conditions for postoperative ventilator weaning for extubation. Respect for patients’ values was utilized to tailor our anesthetic management.
(1.) Barry, Michael J., et al “Shared Decision Making — The Pinnacle of Patient-Centered Care.” New England Journal of Medicine, vol. 366, no. 9, 2012, pp. 780–781.
(2.) Hwang, Sung Mi, et al. “Patient Preference and Satisfaction with Their Involvement in the Selection of an Anesthetic Method for Surgery.” Journal of Korean Medical Science, The Korean Academy of Medical Sciences, Feb. 2014, www.ncbi.nlm.nih.gov/pubmed/24550660.