Surgical palliative care: A multidisciplinary perspective on where we stand and how we need to evolve
by Samuel M. Miller, Paige DeGoursey, Kevin G. Billingsley Surgical palliative care (SPC) integrates the principles of symptom-based care and relief of suffering into traditional surgical practice. From the perspectives of a bedside nurse, surgical critical care fellow, and surgical oncologist, there are natural opportunities to incorporate these principles and in doing so, progress towards SPC…
Surgical palliative care (SPC) is a multidisciplinary approach that integrates symptom-based care and suffering relief into surgical practice. SPC aims to improve quality of life for patients with serious illnesses and offers management for symptoms, pain, and suffering. It also involves transitioning to comfort-based care based on patient preferences and clinical judgement, and effectively communicating prognoses, advance directives, and end-of-life decisions to patients and families.
There are various delivery models for SPC, with the best model depending on resource availability. Implementing SPC requires training for all members of the care team, including surgeons, nurses, trainees, case managers, pharmacists, social workers, and others. Natural opportunities for practicing primary SPC exist at every stage of treatment, such as when considering whether to perform surgery.
During the initial discussion of whether to offer surgery, the surgeon considers the bigger picture and whether surgery helps the patient live a life of value. If surgery is not aligned with the patient's goals, the surgeon discusses the possibility of a nonoperative approach. The surgeon describes possible surgical and non-surgical treatment options, along with their risks and benefits, taking into account the patient's prognosis, hopes, and priorities.
In cases where the prognosis is poor, such as metastatic pancreatic cancer with recurrent bowel obstruction, the surgeon may suggest a venting gastrostomy tube and hospice care at home, which can better align with the patient's goals and values. Discussions about perioperative code status should involve advance directives, allowing patients to express their healthcare preferences in case they cannot communicate them themselves.
Surgical trainees also have opportunities to practice SPC, as patients often present with unmanageable symptoms that require treatment. The surgical team can use these situations to discuss palliative care options with patients and their families, ensuring that decisions align with the patient's values and preferences.
Written by urgent.news from PLOS Medicine's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
