A GUIDE to help patients and families better understand serious illnesses: Mnemonic device provides way to teach learners about advance care planning

Advance care planning (ACP) was identified as a priority in the 2006 final report of the Public Information and Awareness Working Group of the Canadian Strategy on Palliative and End-of-Life Care.1 An important component of ACP is patients’ understanding of their prognoses, which might include expectations related to future function, symptoms, and life expectancy.2-4 Without realistic prognostic information, patients are at risk of not engaging in ACP that would otherwise help them gain control over their illnesses, reduce anxiety, and avoid unwanted treatments.2,3,5 Moreover, lack of that information might lead to challenging downstream goals-of-care conversations. In guidance published in 2023 regarding a physician’s duty to discuss a patient’s medical condition and prognosis during a goals-of-care discussion when the physician deems cardiopulmonary resuscitation not to be indicated, the College of Physicians and Surgeons of Ontario highlighted the importance of physicians being able to communicate prognoses skillfully.6

Author/s:

Helen James, Warren Harris Lewin

Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study

Devin Evans — Thu, 15 Oct 2020 05:00:00 +0000

Date Added:

October 15, 2020

Journal/Publication:

The New England Journal of Medicine

Publication Date:

October 15, 2020

Issue:

383

Pages:

1535-1543

URL:

Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2002449

Keywords

MeSH

cardiovascular diseases

bariatric surgery

In this relatively large, long term Swedish RCT, obese patients treated with bariatric surgery lived 3 years longer on average than those treated medically. Unfortunately, only the abstract can be made available through RPR. James W. Mold, MD, MPH

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BACKGROUND

Obesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear.

METHODS

We used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population.

RESULTS

In total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery.

CONCLUSIONS

Among patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population.

Author/s:

Carlsson, Lena M.S., Sjöholm, Kajsa, Jacobson, Peter, Andersson-Assarsson, Johanna C., Svensson, Per-Arne, Taube, Magdalena, Carlsson, Björn, Peltonen, Markku