Herb Phelan, MD, MSCS, FACS
Like many research projects, the origins of the Prognostic Assessment of Life and Limitations After Trauma in the Elderly [PALLIATE] consortium began with a simple clinical problem. Those of us who care for injured elders are all too familiar with the scenario: an older patient is admitted to the ICU after a serious traumatic event, and we enter the crisis room to update a distraught family on their loved one’s condition. The conversation quickly turns to questions from family members about our prognostic expectations, and we start using subjective statements such as “In my experience…”, or, “Generally speaking…” Alternatively, we may try to bring data to the conversation by speaking of “risk factors” for this or that untoward outcome, but we can see on the faces of these lay people that such verbiage isn’t helping. These vague and subjective answers are frustrating for families given the gravity and irreversibility of some of the treatment choices that face them as they seek to make decisions that are aligned with their older loved one’s values and preferences. I can remember walking out of one such family meeting thinking to myself, “There’s got to be a better way of doing this.”
The result was the PALLIATE consortium. From its modest beginnings, it has grown to its current membership of nine high-performing trauma centers with co-investigators that include national leaders in the fields of geriatrics, palliative care, trauma, biostatistics, critical care, and frailty. To a person, we are all dedicated to improving the quality of information imparted to injured elders and their surrogates. Our earliest efforts have been the creation of award-winning prognosis calculators for the index admission after geriatric trauma, which bring objectivity to goal-setting conversations with an estimate of risk easily understood by lay people. You can find them here in a user-friendly format and completely free of charge. Further, as we look to the future we plan to expand these prognosis calculators to include long-term outcomes after geriatric trauma including quality of life and delayed mortality, as well as investigate better methods of communication between clinicians and family during the stressful time of an ICU stay. It is our vision that the PALLIATE consortium will become a world-wide leader in advancing the science of end of life care for the injured elder.
I’d like to take a moment to thank my colleagues as the men and women of the PALLIATE consortium are among the most talented clinicians and scientists I’ve had the privilege to lead in my career. I’d also like to thank our patients and their families, who in their time of suffering teach us. Without them none of this would be possible.