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The ACS-TQIP palliative care guidelines at two level I trauma centres: a prospective study of patient and caregiver satisfaction
  1. Rebecca Vogel1,
  2. Constance McGraw2,3,
  3. Diane Redmond3,
  4. Pamela Bourg (retired)1,
  5. Chester Dreiman1,
  6. Allen Tanner4,
  7. Neal Lynch4 and
  8. David Bar-Or2,3
  1. 1Trauma Services Department, St Anthony Hospital and Medical Campus, Lakewood, Colorado, USA
  2. 2Trauma Research Department, St Anthony Hospital and Medical Campus, Lakewood, Colorado, USA
  3. 3Trauma Research Department, Penrose Saint Francis Health Services, Colorado Springs, Colorado, USA
  4. 4Trauma Services Department, Penrose Saint Francis Health Services, Colorado Springs, Colorado, USA
  1. Correspondence to Dr David Bar-Or, Trauma Research, St Anthony Hospital and Medical Campus, Lakewood, CO 80113, USA; davidbme49{at}


Objectives To measure trauma patient and caregiver satisfaction before and after implementation of standardised palliative care (PC) guidelines.

Methods Prospective pre–post study at two level-I trauma centres. PC satisfaction surveys were administered prior to discharge for consented trauma patients (Family Satisfaction with Advanced Cancer Scale, Patient (FAMCARE-P13) survey)≥55 years, and their caregivers (FAMCARE survey), from 1 November 2016 to 30 November 2018. Standardised PC guidelines were implemented January 2018 and included consultations, prognostication assessments, identification of proxies, review of advanced directives and do not resuscitate orders within 24 hours of admission, while advanced goals of care, formal family meetings and spiritual care support were recommended within 72 hours of admission. Generalised linear models were used to determine whether differences in patient or caregiver satisfaction existed pre versus post implementation.

Results There were 572 patients (299 pre; 273 post) and 595 caregivers (334 pre; 261 post) included. Overall patient satisfaction significantly increased post implementation (82.0 vs 86.0, p=0.001). After adjustment, the implementation of the guidelines was an independent predictor of higher overall patient satisfaction (least squares mean (LSM= (83.8% (95%CI 81.2%-86.5%) vs 80.3% (77.7%-82.9%), p=0.003)). Compared with preimplementation, patient satisfaction was significantly higher post implementation in the following domains: information giving (80.9 vs 85.5, p=0.001), followed by physical care (82.2 vs 86.0, p=0.002), availability of care (83.4 vs 86.8, p=0.007) and psychosocial care (84.7 vs 87.6, p=0.04). No significant differences in caregiver satisfaction were found before or after adjustment (LSMpre: 83.1% (95%CI 80.9%-85.3%) vs. post: 82.4% (80.3%-84.5%), p=0.56))

Conclusions Our data suggest that the implementation of PC guidelines significantly improved patient satisfaction following traumatic injury, while maintaining robust caregiver satisfaction.

  • supportive care
  • family management
  • education and training
  • communication
  • clinical assessment

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  • Contributors All authors provided final approval of the submitted manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RV is responsible for study conception, literature review, interpretation of the data and critical revisions. CM is responsible for literature review, design, data analysis and interpretation, and drafting the manuscript. DR is responsible for acquisition of data, interpretation of the data and critical revisions. PB, CD, AT, NL and DB-O are responsible for interpretation of the data and critical revisions.

  • Funding The study was investigator initiated and internal funding was provided by St. Anthony Hospital and Penrose St. Francis Health Services.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval in accordance with the Declaration of Helsinki was obtained from the institutional review board at all participating sites before data collection (Catholic Health IRB#s 1023525, 975918). All participants were informed about the purpose and nature of this study and provided written informed consent to be considered for participation in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request from the corresponding author:; ORCID ID: 0000-0002-3685-314X.

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