Ethical issues concerning cardiac surgery in elderly patients — the nurse’s role as a patient advocate: A case report
, 1, 2, 3
Abstract
Introduction: Frailty syndrome (FS) is one of the well-known risk factors for cardiac surgical treatment. Moreover, older patients are more likely to suffer from various comorbidities. Ethical issues that arise in patient care should be considered, including their identification, analysis, and appropriate resolution. The study aimed to present the nurse’s role in the therapeutic team, which should take the floor as a patient
advocate representing her/his interest.
Case presentation: An 82-year-old patient was admitted to the Cardiac Surgery Clinic and was discussed in the context of emerging ethical dilemmas in clinical practice. The peri-operative risk was assessed as high; the nurse identified both frailty phenotype and FS. Currently, at postoperative day 40, the patient remains sedated, haemodynamically unstable, and has a poor long-term prognosis.
Summary: If the patient is not presented with a risk assessment that includes FS assessment during the qualification process, it can be concluded that this omission violates the information component of informed consent. Nurses must speak out in those patients’ interests in order to preclude actions that may increase their vulnerability during cardiac surgery.
Keywords: cardiac surgeryfrailty syndromepatient advocacycase report
References
- Hecker S, Sade R. Ethical Issues in Cardiothoracic Surgery for the Elderly. Cardiothoracic Surgery in the Elderly. 2011: 89–103.
- Vetta F, Locorotondo G, Vetta G, et al. Prognostic impact of frailty in elderly cardiac surgery patients. Monaldi Arch Chest Dis. 2017; 87(2): 855.
- Hubbard RE, Story DA. Patient frailty: the elephant in the operating room. Anaesthesia. 2014; 69 Suppl 1: 26–34.
- Allen KB. Frailty: it's hard to define, but you know it when you see it. J Thorac Cardiovasc Surg. 2014; 148(6): 3117–3118.
- Mueller PS, Hook CC, Fleming KC. Ethical issues in geriatrics: a guide for clinicians. Mayo Clin Proc. 2004; 79(4): 554–562.
- Ridderstolpe L, Collste G, Rutberg H, et al. Priority setting in cardiac surgery: a survey of decision making and ethical issues. J Med Ethics. 2003; 29(6): 353–358.
- Stone ML, Kern JA, Sade RM. Transcatheter aortic valve replacement: clinical aspects and ethical considerations. Ann Thorac Surg. 2012; 94(6): 1791–1795.
- Sepehri A, Beggs T, Hassan A, et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 2014; 148(6): 3110–3117.
- Kavarana MN, Sade RM. Ethical issues in cardiac surgery. Future Cardiol. 2012; 8(3): 451–465.
- Kirsch RE, Coronado J, Roeleveld PP, et al. The Burdens of Offering: Ethical and Practical Considerations. World J Pediatr Congenit Heart Surg. 2017; 8(6): 715–720.
- Gagnier JJ, Kienle G, Altman DG, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. BMJ Case Rep. 2013; 2: 38–43.
- Fried LP, Tangen CM, Walston J, et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3): M146–M156.
- Gobbens RJJ, van Assen MA, Luijkx KG, et al. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010; 11(5): 344–355.
- Uchmanowicz I, Jankowska-Polańska B, Łoboz-Rudnicka M, et al. Cross-cultural adaptation and reliability testing of the Tilburg Frailty Indicator for optimizing care of Polish patients with frailty syndrome. Clin Interv Aging. 2014; 9: 997–1001.
- Tomaschewski-Barlem JG, Lunardi VL, Barlem ELD, et al. Patient advocacy in nursing: barriers, facilitators and potential implications. Texto Contexto Enferm. 2017; 26: 117.
- Davoodvand S, Abbaszadeh A, Ahmadi F. Patient advocacy from the clinical nurses' viewpoint: a qualitative study. J Med Ethics Hist Med. 2016; 9: 5.
- Yanagawa B, Latter DA, Fedak PWM, et al. The Cost of Frailty in Cardiac Surgery. Can J Cardiol. 2017; 33(8): 959–960.
- Afilalo J, Mottillo S, Eisenberg MJ, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012; 5(2): 222–228.
- Hill A. Alkeridy. Preoperative assessment of the frail older adult. Br Columbia Med J. 2017; 59: 112–116.
- Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14(6): 392–397.
- Patron E, Messerotti Benvenuti S, Palomba D. Preoperative and perioperative predictors of reactive and persistent depression after cardiac surgery: a three-month follow-up study. Psychosomatics. 2014; 55(3): 261–271.
- Horne D, Kehler S, Kaoukis G, et al. Depression before and after cardiac surgery: do all patients respond the same? J Thorac Cardiovasc Surg. 2013; 145(5): 1400–1406.
- Nurok M, Makkar R, Gewertz B. The Ethics of Interventional Procedures for Patients Too Ill for Surgery. JAMA. 2017; 317(4): 359–360.
- Graham A, Brown CH. Frailty, Aging, and Cardiovascular Surgery. Anesth Analg. 2017; 124(4): 1053–1060.